Liver Cancer (cont.)
Chemoembolization (trans-arterial chemoembolization or TACE)
This technique takes advantage of the fact that liver cancer is a very vascular
(contains many blood vessels) tumor and gets its blood supply exclusively from
the branches of the hepatic artery. This procedure is similar to intra-arterial
infusion of chemotherapy. But in TACE, there is the additional step of blocking
(embolizing) the small blood vessels with different types of compounds, such as
gelfoam or even small metal coils. Thus, TACE has the advantages of exposing the
tumor to high concentrations of chemotherapy and confining the agents locally
since they are not carried away by the blood stream. At the same time, this
technique deprives the tumor of its needed blood supply, which can result in the
damage or death of the tumor cells.
The type and frequency of complications of TACE and intra-arterial
chemotherapy are similar. The potential disadvantage of TACE is that blocking
the feeding vessels to the tumor(s) may make future attempts at intra-arterial
infusions impossible. Moreover, so far, there are no head-to-head studies
directly comparing the effectiveness of intra-arterial infusion versus
chemoembolization. In Japan, the chemotherapeutic agents are mixed with lipiodol.
The idea is that since the tumor cells preferentially take up lipiodol, they
would likewise take up the chemotherapy. This Japanese technique has not yet
been validated in head-to-head comparisons with conventional TACE.
What are the benefits of TACE? In one large study involving several
institutions in Italy, chemoembolization did not seem to be beneficial. Patients
who did not undergo TACE lived as long as patients who received TACE, even
though the tumors were more likely to shrink in size in patients who were
treated. Does this mean that TACE or intra-arterial chemotherapy does not work?
Maybe, maybe not.
Studies in Japan have shown that TACE can downstage liver cancer. In other words, the
tumors shrank enough to lower (improve) the stage of the cancer. From the
practical point of view, shrinking the tumor creates the option for surgery in
some of these patients. Otherwise, these patients had tumors that were not
operable (eligible for operation) because of the initial large size of their
tumors. More importantly, these same studies showed an improvement in survival
in patients whose tumors became considerably smaller. In the U.S., trials are
underway to see whether doing TACE before liver transplantation increases
patient survival as compared to liver transplantation without TACE.
It is safe to say that TACE or intra-arterial chemoinfusion are palliative
treatment options for liver cancer. This means that these procedures can provide relief
or make the disease less severe. However, they are not curative (do not result
in a cure). Fewer than 50% of patients will have some shrinkage in tumor size.
Further, they can be used only in patients with relatively preserved liver
function. The reason for this is that these procedures, as mentioned previously,
can lead to liver failure in individuals with poor liver function.
Next: Ablation techniques »
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