Skip to main content
SpringerLink
Log in

Transarterial Chemoembolization (TACE) and Combined Therapies

  • Chapter
Percutaneous Tumor Ablation in Medical Radiology

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

  • 1169 Accesses

Abstract

Surgical procedures are a standard treatment of primary and secondary malignant hepatic tumors. However, surgery is only a therapeutic option in 15% of hepatocellular carcinoma (HCC) cases and only overall 5-year survival rates of 25%–40% are reported (Nagasue et al. 1993). On this account new forms of treatments with the aim of an improved survival are needed, such as several promising minimally invasive treatment techniques which may replace or augment surgical resection. These include amongst others new minimally invasive ablative treatment techniques such as laser-induced thermotherapy (LITT), radiofrequency ablation (RF), microwave ablation or cryoablation. The survival rates of these procedures seem to be favorably comparable with those of hepatic surgery (Allgaier et al. 1998; Curley et al. 2000; Dwerryhouse et al. 1998; Finlay et al. 2000; Goldberg et al. 2000; Lencioni et al. 2003; Livraghi 2001; Shibata et al. 2002a; Shiina et al. 2002; Solbiati et al. 2001; Vogl et al. 2002a).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  • Acunas B, Rozanes I (1999) Hepatocellular carcinoma: treatment with transcatheter arterial chemoembolization. Eur J Radiol 32:86–89

    Article  PubMed  CAS  Google Scholar 

  • Albrecht D, Germer CT, Isbert C, Ritz JP, Roggan A, Muller G, Buhr HJ (1998) Interstitial laser coagulation: evaluation of the effect of normal liver blood perfusion and the application mode on lesion size. Lasers Surg Med 23:40–47

    Article  PubMed  CAS  Google Scholar 

  • Allgaier HP, Deibert P, Olschewski M, Spamer C, Blum U, Gerok W, Blum HE (1998) Survival benefit of patients with inoperable hepatocellular carcinoma treated by a combination of transarterial chemoembolization and percutaneous ethanol injection — a single-center analysis including 132 patients. Int J Cancer 79:601–605

    Article  PubMed  CAS  Google Scholar 

  • de Baere T, Bessoud B, Dromain C et al (2002) Percutaneous radiofrequency ablation of hepatic tumors during temporary venous occlusion. AJR Am J Roentgenol 178:53–59

    PubMed  Google Scholar 

  • Bartolozzi C, Lencioni R, Caramella D et al (1995) Treatment of large HCC: transcatheter arterial chemoembolization combined with percutaneous ethanol injection versus repeated transcatheter arterial chemoembolization. Radiology 197:812–818

    PubMed  CAS  Google Scholar 

  • Bloomston M, Binitie O, Fraiji E et al (2002) Transcatheter arterial chemoembolization with or without radiofrequency ablation in the management of patients with advanced hepatic malignancy. Am Surg 68:827–831

    PubMed  Google Scholar 

  • Bruix J, Sherman M, Llovet J et al (2001) Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol 35:421–430

    Article  PubMed  CAS  Google Scholar 

  • Bruix J, Sala M, Llovet J (2004) Chemoembolization for hepatocellular carcinoma. Gastroenterology 127:S179–S188

    Article  PubMed  CAS  Google Scholar 

  • Buscarini L, Buscarini E, Di Stasi M, Quaretti P, Zangrandi A (1999) Percutaneous radiofrequency thermal ablation combined with transcatheter arterial embolization in the treatment of large hepatocellular carcinoma. Ultraschall Med 20:47–53

    Article  PubMed  CAS  Google Scholar 

  • Camma C, Schepis F, Orlando A, Albanese M, Shahied L, Trevisani F, Andreone P, Craxi A, Cottone M (2002) Transarterial chemoembolization for unresectable hepatocellular carcinoma: meta-analysis of randomized controlled trials. Radiology 224:47–54

    Article  PubMed  Google Scholar 

  • Chen HB, Huang Y, Dai DL, Zhang X, Huang ZW, Zhang QK, Wang HH, Zhang JS, Pan G (2004) Therapeutic effect of transcatheter arterial chemoembolization and percutaneous injection of acetic acids on primary liver cancer. Hepatobiliary Pancreat Dis Int 3:55–57

    PubMed  CAS  Google Scholar 

  • Clavien PA, Kang KJ, Selzner N, Morse MA, Suhocki PV (2002) Cryosurgery after chemoembolization for hepatocellular carcinoma in patients with cirrhosis. J Gastrointest Surg 6:95–101

    Article  PubMed  Google Scholar 

  • Curley SA, Izzo F (2002) Radiofrequency ablation of primary and metastatic hepatic malignancies. Int J Clin Oncol 7:72–81

    PubMed  Google Scholar 

  • Curley SA, Izzo F, Ellis LM, Nicolas Vauthey J, Vallone P (2000) Radiofrequency ablation of hepatocellular cancer in 110 patients with cirrhosis. Ann Surg 232:381–391

    Article  PubMed  CAS  Google Scholar 

  • Dohmen K, Shirahama M, Shigematsu H, Miyamoto Y, Torii Y, Irie K, Ishibashi H (2001) Transcatheter arterial chemoembolization therapy combined with percutaneous ethanol injection for unresectable large hepatocellular carcinoma: an evaluation of the local therapeutic effect and survival rate. Hepatogastroenterology 48:1409–1415

    PubMed  CAS  Google Scholar 

  • Dwerryhouse SJ, Seifert JK, McCall JL, Iqbal J, Ross WB, Morris DL (1998) Hepatic resection with cryotherapy to involved or inadequate resection margin (edge freeze) for metastases from colorectal cancer. Br J Surg 85:185–187

    Article  PubMed  CAS  Google Scholar 

  • Fan J, Tang ZY, Yu YQ, Wu ZQ, Ma ZC, Zhou XD, Zhou J, Qiu SJ, Lu JZ (1998) Improved survival with resection after transcatheter arterial chemoembolization (TACE) for unresectable hepatocellular carcinoma. Dig Surg 15:674–678

    Article  PubMed  CAS  Google Scholar 

  • Finlay IG, Seifert JK, Stewart GJ, Morris DL (2000) Resection with cryotherapy of colorectal hepatic metastases has the same survival as hepatic resection alone. Eur J Surg Oncol 26:199–202

    Article  PubMed  CAS  Google Scholar 

  • Fiorentini G, Poddie DB, Giorgi UD et al (2000) Global approach to hepatic metastases from colorectal cancer: indication and outcome of intra-arterial chemotherapy and other hepatic-directed treatments. Med Oncol 17:163–173

    PubMed  CAS  Google Scholar 

  • Goldberg SN, Gazelle GS, Compton CC, Mueller PR, Tanabe KK (2000) Treatment of intrahepatic malignancy with radiofrequency ablation: radiologic-pathologic correlation. Cancer 88:2452–2463

    Article  PubMed  CAS  Google Scholar 

  • Guo WJ, Yu EX, Liu LM, Li J, Chen Z, Lin JH, Meng ZQ, Feng Y (2003) Comparison between chemoembolization combined with radiotherapy and chemoembolization alone for large hepatocellular carcinoma. World J Gastroenterol 9:1697–1701

    PubMed  Google Scholar 

  • Heisterkamp J, van Hillegersberg R, Mulder PG, Sinofsky EL, Ijzermans JN (1997) Importance of eliminating portal flow to produce large intrahepatic lesions with interstitial laser coagulation. Br J Surg 84:1245–1248

    Article  PubMed  CAS  Google Scholar 

  • Hiraki T, Kanazawa S (2005) Hepatic outflow obstruction created by balloon occlusion of the hepatic vein: induced hepatic hemodynamic changes and the therapeutic applications of hepatic venous occlusion with a balloon catheter in interventional radiology. Acta Med Okayama 59:171–178

    PubMed  Google Scholar 

  • Ishida T, Murakami T, Shibata T, Inoue Y, Takamura M, Niinobu T, Sato T, Nakamura H (2002) Percutaneous microwave tumor coagulation for hepatocellular carcinomas with interruption of segmental hepatic blood flow. J Vasc Interv Radiol 13:185–191

    Article  PubMed  Google Scholar 

  • Ishikawa M, Ikeyama S, Sasaki K et al (2000) Intraoperative microwave coagulation therapy for large hepatic tumors. J Hepatobiliary Pancreat Surg 7:587–591

    Article  PubMed  CAS  Google Scholar 

  • Itamoto T, Katayama K, Fukuda S et al (2001) Percutaneous microwave coagulation therapy for primary or recurrent hepatocellular carcinoma: long-term results. Hepatogastroenterology 48:1401–1405

    PubMed  CAS  Google Scholar 

  • Kirchhoff T, Chavan A, Galanski M (1998) Transarterial chemoembolization and percutaneous ethanol injection therapy in patients with hepatocellular carcinoma [comment]. Eur J Gastroenterol Hepatol 10:907–909

    Article  PubMed  CAS  Google Scholar 

  • Kitamoto M, Imagawa M, Yamada H et al (2003) Radiofrequency ablation in the treatment of small hepatocellular carcinomas: comparison of the radiofrequency effect with and without chemoembolization. AJR Am J Roentgenol 181:997–1003

    PubMed  Google Scholar 

  • Lencioni R, Paolicchi A, Moretti M et al (1998) Combined transcatheter arterial chemoembolization and percutaneous ethanol injection for the treatment of large hepatocellular carcinoma: local therapeutic effect and longterm survival rate. Eur Radiol 8:439–444

    Article  PubMed  CAS  Google Scholar 

  • Lencioni RA, Allgaier HP, Cioni D et al (2003) Small hepatocellular carcinoma in cirrhosis: randomized comparison of radio-frequency thermal ablation versus percutaneous ethanol injection. Radiology 228:235–240

    Article  PubMed  Google Scholar 

  • Liang JD, Yang PM, Huang GT, Lee HS, Chen CH, Liang PC, Sheu JC, Chen DS (2004) Percutaneous microwave coagulation therapy under ultrasound guidance for small hepatocellular carcinoma. J Formos Med Assoc 103:908–913

    PubMed  Google Scholar 

  • Livraghi T (2001) Guidelines for treatment of liver cancer. Eur J Ultrasound 13:167–176

    Article  PubMed  CAS  Google Scholar 

  • Lubienski A, Bitsch RG, Schemmer P, Grenacher L, Dux M, Kauffmann GW (2004) Long-term results of interventional treatment of large unresectable hepatocellular carcinoma (HCC): significant survival benefit from combined transcatheter arterial chemoembolization (TACE) and percutaneous ethanol injection (PEI) compared to TACE monotherapy. Rofo 176:1794–1802

    PubMed  CAS  Google Scholar 

  • Matsuura M, Nakajima N, Arai K, Ito K (1998) The usefulness of radiation therapy for hepatocellular carcinoma. Hepatogastroenterology 45:791–796

    PubMed  CAS  Google Scholar 

  • Matthewson K, Coleridge-Smith P, O’Sullivan JP, Northfield TC, Bown SG (1987) Biological effects of intrahepatic neodymium: yttrium-aluminum-garnet laser photocoagulation in rats. Gastroenterology 93:550–557

    PubMed  CAS  Google Scholar 

  • Nagasue N, Kohno H, Chang YC et al (1993) Liver resection for hepatocellular carcinoma. Results of 229 consecutive patients during 11 years. Ann Surg 217:375–384

    Article  PubMed  CAS  Google Scholar 

  • Qian GJ, Chen H, Wu MC (2003) Percutaneous cryoablation after chemoembolization of liver carcinoma: report of 34 cases. Hepatobiliary Pancreat Dis Int 2:520–524

    PubMed  Google Scholar 

  • Raoul JL, Guyader D, Bretagne JF, Heautot JF, Duvauferrier R, Bourguet P, Bekhechi D, Deugnier YM, Gosselin M (1997) Prospective randomized trial of chemoembolization versus intra-arterial injection of 131I-labeled-iodized oil in the treatment of hepatocellular carcinoma. Hepatology 26:1156–1161

    PubMed  CAS  Google Scholar 

  • Rossi S, Garbagnati F, Lencioni R et al (2000) Percutaneous radio-frequency thermal ablation of nonresectable hepatocellular carcinoma after occlusion of tumor blood supply. Radiology 217:119–126

    PubMed  CAS  Google Scholar 

  • Seong J, Keum KC, Han KH, Lee DY, Lee JT, Chon CY, Moon YM, Suh CO, Kim GE (1999) Combined transcatheter arterial chemoembolization and local radiotherapy of unresectable hepatocellular carcinoma. Int J Radiat Oncol Biol Phys 43:393–397

    Article  PubMed  CAS  Google Scholar 

  • Seong J, Park HC, Han KH et al (2000) Local radiotherapy for unresectable hepatocellular carcinoma patients who failed with transcatheter arterial chemoembolization. Int J Radiat Oncol Biol Phys 47:1331–1335

    Article  PubMed  CAS  Google Scholar 

  • Shibata T, Iimuro Y, Yamamoto Y, Maetani Y, Ametani F, Itoh K, Konishi J (2002a) Small hepatocellular carcinoma: comparison of radio-frequency ablation and percutaneous microwave coagulation therapy. Radiology 223:331–337

    Article  PubMed  Google Scholar 

  • Shibata T, Morita T, Okuyama M, Kitada M, Shimano T, Ishida T (2002b) Comparison of percutaneous microwave coagulation area under interruption of hepatic arterial blood flow with that under hepatic arterial and venous blood flow for hepatocellular carcinoma. Gan To Kagaku Ryoho 29:2146–2148

    PubMed  Google Scholar 

  • Shiina S, Teratani T, Obi S, Hamamura K, Koike Y, Omata M (2002) Nonsurgical treatment of hepatocellular carcinoma: from percutaneous ethanol injection therapy and percutaneous microwave coagulation therapy to radiofrequency ablation. Oncology 62:64–68

    Article  PubMed  CAS  Google Scholar 

  • Simon CJ, Dupuy DE, Mayo-Smith WW (2005) Microwave ablation: principles and applications. Radiographics 25[Suppl 1]:S69–S83

    Article  PubMed  Google Scholar 

  • Solbiati L, Livraghi T, Goldberg SN, Ierace T, Meloni F, Dellanoce M, Cova L, Halpern EF, Gazelle GS (2001) Percutaneous radio-frequency ablation of hepatic metastases from colorectal cancer: long-term results in 117 patients. Radiology 221:159–166

    Article  PubMed  CAS  Google Scholar 

  • Takamura M, Murakami T, Shibata T et al (2001) Microwave coagulation therapy with interruption of hepatic blood in-or outflow: an experimental study. J Vasc Interv Radiol 12:619–622

    Article  PubMed  CAS  Google Scholar 

  • Tancredi T, McCuskey PA, Kan Z, Wallace S (1999) Changes in rat liver microcirculation after experimental hepatic arterial embolization: comparison of different embolic agents. Radiology 211:177–181

    PubMed  CAS  Google Scholar 

  • Tellez C, Benson AB 3rd, Lyster MT, Talamonti M, Shaw J, Braun MA, Nemcek AA Jr, Vogelzang RL (1998) Phase II trial of chemoembolization for the treatment of metastatic colorectal carcinoma to the liver and review of the literature. Cancer 82:1250–1259

    Article  PubMed  CAS  Google Scholar 

  • Trevisani F, De Notariis S, Rossi C, Bernardi M (2001) Randomized control trials on chemoembolization for hepatocellular carcinoma: is there room for new studies? J Clin Gastroenterol 32:383–389

    Article  PubMed  CAS  Google Scholar 

  • Verhoef C, Kuiper JW, Heisterkamp J et al (2003) Interstitial laser coagulation with temporary hepatic artery occlusion for patients with cirrhosis and irresectable hepatoma. Br J Surg 90:950–955

    Article  PubMed  CAS  Google Scholar 

  • Vogl TJ, Trapp M, Schroeder H, Mack M, Schuster A, Schmitt J, Neuhaus P, Felix R (2000) Transarterial chemoembolization for hepatocellular carcinoma: volumetric and morphologic CT criteria for assessment of prognosis and therapeutic success — results from a liver transplantation center. Radiology 214:349–357

    PubMed  CAS  Google Scholar 

  • Vogl TJ, Straub R, Eichler K, Woitaschek D, Mack MG (2002a) Malignant liver tumors treated with MR imaging-guided laser-induced thermotherapy: experience with complications in 899 patients (2,520 lesions). Radiology 225:367–377

    Article  PubMed  Google Scholar 

  • Vogl TJ, Zangos S, Balzer JO, Thalhammer A, Mack MG (2002b) Transarterial chemoembolization of liver metastases: Indication, technique, results. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 174:675–683

    Article  PubMed  Google Scholar 

  • Vogl TJ, Mack MG, Balzer JO, Engelmann K, Straub R, Eichler K, Woitaschek D, Zangos S (2003) Liver metastases: neoadjuvant downsizing with transarterial chemoembolization before laser-induced thermotherapy. Radiology 229:457–464

    Article  PubMed  Google Scholar 

  • Wacker FK, Reither K, Ritz JP, Roggan A, Germer CT, Wolf KJ (2001) MR-guided interstitial laser-induced thermotherapy of hepatic metastasis combined with arterial blood flow reduction: technique and first clinical results in an open MR system. J Magn Reson Imaging 13:31–36

    Article  PubMed  CAS  Google Scholar 

  • Whelan WM, Wyman DR, Wilson BC (1995) Investigations of large vessel cooling during interstitial laser heating. Med Phys 22:105–115

    Article  PubMed  CAS  Google Scholar 

  • Yamakado K, Nakatsuka A, Akeboshi M, Shiraki K, Nakano T, Takeda K (2004) Combination therapy with radiofrequency ablation and transcatheter chemoembolization for the treatment of hepatocellular carcinoma: shortterm recurrences and survival. Oncol Rep 11:105–109

    PubMed  Google Scholar 

  • Zangos S, Mack MG, Straub R, Engelmann K, Eichler K, Balzer J, Vogl TJ (2001) Transarterial chemoembolization (TACE) of liver metastases. A palliative therapeutic approach. Radiologe 41:84–90

    Article  PubMed  CAS  Google Scholar 

  • Zangos S, Mack MG, Balzer JO et al (2004) Neoadjuvant transarterial chemoembolization (TACE) before percutaneous laser-induced thermotherapy (LITT): results in large-sized primary and secondary liver tumors. Medical Laser Application 19:98–108

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institute for Diagnostic and Interventional Radiology, University Hospital, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany

    Stephan Zangos MD, Katrin Eichler MD, Martin G. Mack MD (PD) & Thomas J. Vogl MD (Professor)

Authors
  1. Stephan Zangos MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Katrin Eichler MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Martin G. Mack MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Thomas J. Vogl MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Institute for Diagnostic and Interventional Radiology University Hospital, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany

    Thomas J. Vogl MD (Professor) & Martin G. Mack MD (PD) (Professor) &  (PD)

  2. Department of Diagnostic and Interventional Radiology and Nuclear Medicine Klinikum Bogenhausen, Academic Teaching, Hospital of the Technical University Munich, Engelschalkingerstrasse 77, 81925, Munich, Germany

    Thomas K. Helmberger MD (Professor) (Professor)

  3. Department of Clinical Radiology University Hospitals — Grosshadern and Innenstadt, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany

    Maximilian F. Reiser MD (Professor and Chairman) (Professor and Chairman)

Rights and permissions

Reprints and permissions

Copyright information

© 2008 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Zangos, S., Eichler, K., Mack, M.G., Vogl, T.J. (2008). Transarterial Chemoembolization (TACE) and Combined Therapies. In: Vogl, T.J., Helmberger, T.K., Mack, M.G., Reiser, M.F. (eds) Percutaneous Tumor Ablation in Medical Radiology. Medical Radiology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-68250-9_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-540-68250-9_12

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-22518-8

  • Online ISBN: 978-3-540-68250-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation