Quality-Improvement Guidelines for Hepatic Transarterial Chemoembolization

Excerpt

Transarterial chemoembolization (TACE) was first introduced in 1977 by Dr. Yamada, who exploited hepatocellular carcinoma’s (HCC) preferential blood supply from the hepatic artery for the delivery of antitumor therapy. His findings on an initial cohort of 120 patients were published in the English literature in 1983 [1]. Conventional transarterial chemoembolization (c-TACE) involves the selective injection of a chemotherapeutic agent, or a combination of different chemotherapeutic agents emulsified, in a viscous carrier (lipiodol), followed by embolic material, into the feeding arteries of the tumor. The aim is to obtain higher intratumoral drug concentrations compared with intravenous therapy, with tumor infarction and necrosis due to vascular occlusion [2]. Commonly the chemotherapeutic drug is mixed with lipiodol, a contrast medium that contains iodinated poppy-seed oil. Lipiodol is routinely used for arterial embolization and after injection by way of the hepatic artery has the characteristic of persisting in tumor nodules for a few weeks or months due to the high vascularity of tumor tissue and the absence of Kupffer cells. Subsequent embolization of the feeding arteries should decrease arterial inflow, decrease washout of the chemotherapeutic agent, and decrease systemic exposure. However, on the basis of recent scientific evidence [3], lipiodol is not able to slowly release chemotherapeutic agents into neoplastic tissue, and some systemic effects may be related to a high level of drug being rapidly released into the systemic circulation. …