Transarterial Chemoembolization

  • Christos Georgiades
  • Jean-Francois Geschwind


This chapter discusses transarterial chemoembolization (TACE), which has become the mainstay of treatment for unresectable hepatocellular carcinoma (HCC). Its success is attributable to the ability to deliver high-dose chemotherapy into the tumor vascular bed. The addition of emulsifying agents (i.e., lipiodol) and/or particles to the chemotherapy slows down the blood flow through the tumor blood supply and increases the chemotherapy residence time. Recent technological advances such as drug eluting beads further increase the intra-tumoral drug concentration and residence time, while limiting the plasma concentration. This results in increased tumoricidal effect and less systemic toxicity related to TACE. The survival benefit from TACE has been repeatedly shown to be more than double that of supportive care or systemic chemotherapy alone, with less toxicity. The approval of targeted agents for the treatment of unresectable HCC, such as Sorafenib, can have synergistic effect with TACE on survival. Combination treatments that include TACE, ablation, and systemic maintenance chemotherapy will soon become the standard of care for patients with unresectable HCC. These treatments will also likely result in downsizing of many previously unresectable or non-transplantable patients, a likely benefit but also a challenge to ensure such treatment course is appropriate. Whatever the new standard treatment protocol is for HCC is undoubtedly TACE will play the central role.


Chemoembolization TACE Hepatocellular carcinoma Drug eluting beads 


  1. 1.
    Devita VT, Lawrence TS, Rosenberg SA, eds (2008) DeVita, Hellman & Rosenberg’s Cancer: principles and practice of oncology, 8th ed. Wolters Kluwer and Lippincot Williams & Wilkins, Philadelphia, PAGoogle Scholar
  2. 2.
    Llovet JM, Ricci S, Mazzaferro V, Hilgard P, Raoul J, Zeuzem S, Poulin-Costello M, Moscovici M, Voliotis D, Bruix J, For the SHARP Investigators Study Group J Clin Oncol (2007) Sorafenib improves survival in advanced hepatocellular carcinoma (HCC): results of a phase III randomized placebo-controlled trial (SHARP trial). ASCO Annual Meeting Proceedings Part I 25(June 20 Supplement), LBA1Google Scholar
  3. 3.
    Llovet JM, Real MI, Montana X et al (2002) Arterial embolization or chemoembolization versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomized controlled trial. Lancet 1:1734–1739CrossRefGoogle Scholar
  4. 4.
    Camma C, Schepis F, Orlando A et al (2002) Transarterial chemoembolization for unresectable hepatocellular carcinoma: meta-analysis of randomized controlled trials. Radiology 1:47–54CrossRefGoogle Scholar
  5. 5.
    Lo CM, Ngan H, Tso WK et al (2002) Randomized control trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology 1:1164–1171CrossRefGoogle Scholar
  6. 6.
    Llovet JM, Bruix J (2003) Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. Hepatology 1:429–442CrossRefGoogle Scholar
  7. 7.
    Yamagiwa K, Shiraki K, Yamakado K et al (2008) Survival rates according to the Cancer of the Liver Italian Program scores of 345 hepatocellular carcinoma patients after multimodality treatments during a 10-year period in a retrospective study. J Gastroenterol Hepatol 1:482–490CrossRefGoogle Scholar
  8. 8.
    Yamakado K, Nakatsuka A, Takaki H et al (2008) Early stage hepatocellular carcinoma: radiofrequency ablation combined with chemoembolization versus hepatectomy. Radiology 1:260–266CrossRefGoogle Scholar
  9. 9.
    Graziadei IW, Sandmueller H, Waldenberger P et al (2003) Chemoembolization followed by liver transplantation for hepatocellular carcinoma impedes tumor progression while on the waiting list and leads to excellent outcome. Liver Transplant 1:557–563CrossRefGoogle Scholar
  10. 10.
    Stockland HA, Walser EM, Paz-Fumagalli R, McKinney JM, May GR (2007) Preoperative chemoembolization in patients with hepatocellular carcinoma undergoing liver transplantation: influence of emergent versus elective procedures on patient survival and tumor recurrence rates. Cardiovasc Intervent Radiol 1:888–893CrossRefGoogle Scholar
  11. 11.
    Ravaioli M, Grazi GL, Ercolani G et al (2004) Partial necrosis on hepatocellular carcinoma nodules facilitates tumor recurrence after liver transplantation. Transplantation 1:1780–1786CrossRefGoogle Scholar
  12. 12.
    Buijs M, Vossen JA, Frangakis C, Hong K, Georgiades CS, Chen Y, Liapi E, Geschwind JF (2008) Nonresectable hepatocellular carcinoma: long-term to treated with transarterial chemoembolization: a single centre experience. Radiology 1:346–354CrossRefGoogle Scholar
  13. 13.
    Poon RT, Tso WK, Pang RW et al (2007) A phase I/II trial of chemoembolization for hepatocellular carcinoma using a novel intra-arterial drug-eluting bead. Clin Gastroenterol Hepatol 5:1100–1108CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Christos Georgiades
    • 1
  • Jean-Francois Geschwind
    • 1
  1. 1.Department of RadiologyJohns Hopkins University School of MedicineBaltimoreUSA

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