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 artery.
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. These techniques can be used to treat secondary, or metastatic liver cancer, which is cancer that spread to the liver from other primary sites. These metastases also draw their blood suupply from the hepatic arteries. This discussion will focus on promary liver cancer. Making use of this pattern of blood supply, 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 by relying on the liver to extract or breakdown some of the chemotherapy after the tumor has been exposed to it.
What are the side effects and benefits of arterial chemotherapy infusion?
In reality, however, depenign on the chemotherapeutic agent used, much of the drug 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 resultin 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.