Dr. Fong is the Medical Director of the USC Liver Transplant Program and Associate Professor of Medicine at the USC Keck School of Medicine. He obtained his medical degree from the University of Southern California and completed his residency in Internal Medicine at Los Angeles County-USC Medical Center. He is board certified in Internal Medicine and the subspecialty of Gastroenterology.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Arterial chemotherapy infusion of the liver and chemoembolization of the
liver (transarterial chemoembolization or TACE) are similar procedures that are
used for the treatment of liver cancers. In both procedures, chemotherapy is
injected into the hepatic (liver) artery that supplies the liver tumor. The
difference between the two procedures is that in chemoembolization, additional
material is injected to block (embolize) the small branches of the hepatic
Arterial Chemotherapy Infusion of the Liver
Why is the chemotherapy
injected into the hepatic artery?
The normal liver gets its blood supply from two sources: the portal vein
(about 70%) and the hepatic artery (30%). Primary liver cancer, also known as
hepatoma or hepatocellular carcinoma (HCC) gets its blood exclusively from the
hepatic artery. Making use of this fact, investigators have delivered
chemotherapy agents selectively through the hepatic artery directly to the HCC
tumor. The theoretical advantage is that higher concentrations of the agents can
be delivered to the tumors without subjecting the patients to the systemic
toxicity of the agents.
What are the side effects and benefits of
arterial chemotherapy infusion?
In reality, however, much of the chemotherapeutic agents
does end up in the rest of the body. Therefore, selective intra-arterial chemotherapy
can cause the
usual systemic (body-wide) side effects. In addition, this treatment can result
in some regional side effects, such as inflammation of the gallbladder
(cholecystitis), intestinal and stomach ulcers, and inflammation of the pancreas
(pancreatitis). HCC patients with
advanced cirrhosis may develop liver failure after this treatment. Well then,
what is the benefit of intra-arterial chemotherapy? The bottom line is that
fewer than 50% of HCC patients will experience a reduction in tumor size.
Just how is arterial chemotherapy infusion
An interventional radiologist (one who does therapeutic procedures) usually
carries out this procedure. The radiologist must work closely with an oncologist
(cancer specialist), who determines the amount of chemotherapy that the patient
receives at each session. Some patients may undergo repeat sessions at six- to 12-week intervals. This procedure is done with the help of fluoroscopy (type of
x-ray) imaging. A catheter (long, narrow tube) is inserted into the femoral
artery in the groin and is threaded into the aorta (the main artery of the
body). From the aorta, the catheter is advanced into the hepatic artery. Once
the branches of the hepatic artery that feed the liver cancer are identified,
the chemotherapy is infused. The whole procedure takes one to two hours, and
then the catheter is removed.