Chemoembolisation (TACE) and Ablation of Tumours

What is Chemoembolisation (TACE)?

Transarterial Chemoembolisation, or TACE, is an Interventional Radiology procedure used primarily to treat Hepatocellular Carcinoma (HCC liver cancer). The procedure works on a brilliant principle: tumours in the liver receive most of their blood supply from the hepatic artery, while normal liver tissue is supplied mainly by the portal vein. TACE exploits this difference by catheterising the hepatic artery under fluoroscopic guidance, injecting a combination of chemotherapy agents and embolic particles directly into the tumour's blood supply. This achieves a dual effect concentrated chemotherapy kills tumour cells while embolisation cuts off the blood supply, causing tumour ischaemia.

• Performed under local anaesthesia and sedation
• Small catheter inserted via the groin artery
• Chemotherapy delivered directly to the tumour
• Blood supply to the tumour is simultaneously blocked
• Dramatically higher drug concentration at tumour site than systemic chemotherapy

Types of TACE Conventional vs. DEB-TACE

There are two main forms of TACE. Conventional TACE (cTACE) involves the injection of a mixture of chemotherapy drugs (typically doxorubicin, cisplatin, or mitomycin C) with lipiodol, followed by embolic particles. Drug-Eluting Bead TACE (DEB-TACE) uses specially designed microspheres that are loaded with chemotherapy drugs. These beads release the chemotherapy in a controlled, sustained manner at the tumour site achieving higher local drug concentration with fewer systemic side effects. Dr. Shetty selects the appropriate TACE technique based on tumour size, number, location, and the patient's overall liver function.

What is Percutaneous Tumour Ablation?

Percutaneous tumour ablation refers to a group of techniques where a needle or probe is inserted through the skin (under CT or ultrasound guidance) directly into the tumour, which is then destroyed using heat, cold, or other energy forms. The most common modalities include Radiofrequency Ablation (RFA), where electrical energy generates heat to destroy tumour tissue; Microwave Ablation (MWA), which uses microwave energy to rapidly heat and ablate the tumour at higher temperatures than RFA; and Cryoablation, which uses extreme cold to freeze and destroy tumour cells. Percutaneous ablation is used for tumours in the liver, kidney, lung, bone, and soft tissue.

• Minimally invasive only a needle insertion through the skin
• Performed under CT or ultrasound guidance
• General anaesthesia usually not required
• Day procedure for many patients
• Can treat multiple tumours in one session
• Suitable for patients unfit for surgery

Who is a Candidate for TACE or Ablation?

TACE is most commonly recommended for patients with HCC (liver cancer) who are not suitable candidates for surgical resection or liver transplantation often because of tumour size, number, or position. It is also used as a bridge therapy to keep tumour growth controlled while awaiting liver transplantation. Ablation is particularly suitable for small, localised tumours in the liver, kidney, or lung, where surgery would carry high risk or is not the patient's preference. Dr. Shetty evaluates each patient individually, considering tumour characteristics, liver function (Child-Pugh score), performance status, and overall health to determine the most appropriate treatment.

What to Expect Recovery and Outcomes

Most TACE patients are hospitalised for 2–3 days. Post-embolisation syndrome mild fever, nausea, and abdominal discomfort — is common and expected as the body responds to the procedure. This typically resolves within a week. Follow-up imaging (CT or MRI) is performed at 4–6 weeks to assess tumour response. Multiple TACE sessions may be required. Ablation patients often require only an overnight hospital stay. Response to treatment is assessed using the mRECIST criteria for liver lesions. Studies show TACE significantly improves survival in intermediate-stage HCC compared to best supportive care alone, and ablation achieves complete response rates of over 90% for small liver tumours.