What is TACE (Chemoembolisation)?
Transarterial Chemoembolisation (TACE) is the globally established standard of care for intermediate-stage hepatocellular carcinoma (HCC) and is also used for liver metastases. A catheter is navigated through the femoral artery into the hepatic artery branches supplying the tumour, where a combination of chemotherapy drugs and embolic particles is injected. This simultaneously delivers chemotherapy at concentrations up to 100 times higher than systemic treatment directly to the tumour, while completely cutting off its blood supply inducing extensive tumour cell death while sparing normal liver tissue, which has a dual blood supply from the portal vein.
Who is this procedure for?
TACE is recommended for patients with unresectable hepatocellular carcinoma (HCC) and preserved liver function (Child-Pugh A or B), patients with multinodular disease or tumours too large for ablation alone, and selected patients with liver-dominant metastases (particularly from colorectal, neuroendocrine, or breast primaries). It is also used as a bridge therapy to liver transplantation to prevent tumour progression while awaiting a donor organ, and to downstage large HCCs to make them eligible for curative surgery or transplant.
How is the procedure performed?
- A thin catheter is introduced through the femoral artery in the groin under local anaesthesia and navigated under X-ray guidance into the hepatic artery.
- The catheter is advanced super-selectively into the specific branch of the hepatic artery feeding the tumour, guided by real-time fluoroscopy.
- A hepatic angiogram (contrast X-ray) is performed to map the tumour's blood supply precisely and confirm optimal catheter position.
- A carefully prepared mixture of chemotherapy (doxorubicin, cisplatin, or drug-eluting microspheres) and embolic particles is injected slowly into the feeding artery.
- Completion angiography confirms successful tumour devascularisation the tumour's blood supply is now blocked.
- The catheter is removed; the patient is admitted overnight and typically discharged the following morning after observation.
