TACE: Interventional therapy for liver malignant tumors

TACE: Interventional therapy for liver malignant tumors. Many countries have reported that individual patients have survived for more than ten years after treatment (TACE).

Liver malignancies include primary liver cancer and metastatic liver cancer.

Surgical resection is the main treatment for early liver cancer, but the onset of liver cancer is hidden and the degree of malignancy is high. Most patients are in the middle and late stage when they see a doctor. The success rate of surgical resection is low, and non-surgical treatment is mostly used. With the development of vascular interventional radiology, transcatheter arterial chemoembolization (TACE) as the main method has become the recognized method of choice for non-surgical treatment of liver cancer.

TACE is intubated through the femoral artery, selectively inserted into the blood supply artery for liver cancer, embolization and infusion of chemotherapy drugs, embolization of the main tumor blood vessels to block the tumor blood supply, cause tumor ischemia necrosis, and infusion of chemotherapy drugs to kill tumor cells , Indications: Liver cancer with rich blood supply. Advantages: less trauma, mild side effects, can be treated repeatedly for many times, improve the quality of life, and prolong life.

The efficacy of chemoembolization combined with radiofrequency ablation on early hepatocellular carcinoma showed that the long-term survival rate and disease-free survival rate of patients were similar to those of surgical resection alone. TACE combined with other treatments may become an alternative treatment for surgery, bringing new hope to patients with unresectable tumors.

1. Basic principles:

The growth of tumor depends on the formation of new blood vessels in the tumor. As an important clinical treatment of liver cancer, TACE mainly embolizes the tumor’s blood supply artery to block the tumor’s blood supply, resulting in tumor ischemia and hypoxia, achieving the purpose of inhibiting tumor growth and promoting tumor cell necrosis and apoptosis.

Since 95%-99% of the blood supply of liver cancer comes from the hepatic artery, 25%-30% of the blood supply of normal liver tissue comes from the hepatic artery, and 70%-75% comes from the portal vein, embolization of the hepatic artery can effectively block the blood supply of the tumor. It reduces necrosis, but has little effect on the blood vessels of the liver tissue; intraarterial injection of chemotherapeutic drugs can increase the local drug concentration of the tumor, improve the therapeutic effect and reduce the toxic side effects of the drug on the whole body.

2. Indications:

Applicable to primary liver cancer and postoperative recurrence of liver cancer (Child classification of liver function is A, B-grade).

3. Operation method:

Percutaneous arterial puncture is used, a short guide wire is used to insert the catheter sheath, and then the intubation operation is performed under X-ray fluoroscopy. After the catheter is selectively inserted into the tumor supply artery, angiography is performed to understand the distribution of the supply artery and tumor blood vessel. Infusion of chemotherapy drugs or embolization drugs through the catheter.

Embolic agents that are widely used in arterial embolization therapy include iodized oil emulsion, gelatin sponge, PVA (polyvinyl alcohol) particles, and drug microspheres. After the treatment, extubation, compression of the puncture site to stop bleeding, immobilization on the side of the puncture limb for 12 hours, lying supine for 24 hours to prevent bleeding and hematoma formation at the puncture site.

4. Curative effect of liver cancer intervention:

Mainly related to the malignant degree and biological behavior of the primary tumor. The survival period of untreated patients with intermediate and advanced liver cancer is 3-6 months; interventional therapy enables patients to survive with the tumor. It is reported in the literature that the intermediate and advanced liver cancer undergoes interventional treatment Later, the survival period can be significantly extended.

5. Factors affecting prognosis:

• 1. Tumor blood supply: the more abundant the blood supply, the better the effect;
• 2. Tumor capsule: those with capsule have good curative effect;
• 3. The lighter the liver cirrhosis, the better the curative effect. The curative effect is better if there is no arteriovenous fistula, and the curative effect is better if there is no ascites;
• 4. The elderly are better than the younger ones;
• 5. Cheerful, strong-willed, and good for those who take proper rest.

6. Timing of treatment:

1) The interval should be determined according to specific conditions, such as tumor size, lipiodol accumulation, liver function changes, blood picture and general condition. Generally it can be repeated every 4 to 6 weeks. For middle-advanced liver cancer, one embolization often fails to completely control tumor growth, and requires two or more TACE and/or other treatment methods.

2) The basic conditions for choosing retreatment: the previous treatment is effective; the mass is reduced; the AFP level is still high or elevated; the radiography shows that there are still lesions that are not filled with lipiodol or new lesions; liver function is normal or mildly abnormal, it is estimated Those who can be treated again. The general principle is to minimize the number of treatments while keeping the tumor under control and living with the tumor, so as to improve the quality of life of patients and reduce the economic burden.

Our center has carried out hepatic artery chemoembolization (TACE) for many years and has rich clinical experience. After treatment, most of the patients’ tumors have shrunk to varying degrees, the survival time is prolonged, and the quality of life is improved. Some patients have survived for several years. There are reports at home and abroad that individual patients have survived for more than ten years after treatment (TACE).

(source:internet, reference only)

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