Discussion

TACE has been shown in a number of human randomized clinical trials to be associated with prolonged survival times when compared with systemic therapies.^1,2 Drug-eluting beads slowly elute the doxorubicin over weeks to months within the tumor, resulting in less toxicity to patients, most of which show no side effects from the chemotherapy (such as immunocompromise or gastrointestinal toxicoses associated with systemic delivery).³

Postembolization syndrome, which is characterized by general malaise, fever, nausea and abdominal discomfort, occurs in many people after TACE. The syndrome is generally self-limiting and well-managed with supportive care such as anti-inflammatories, antinausea medications, antibiotics, pain medications and gastroprotectants. In addition, drug-eluting bead TACE therapy has been shown to result in fewer side effects such as postembolization syndrome and better results (for large tumors) than standard chemoembolization.⁴ It is unclear if animals experience postembolization syndrome, but we currently treat them empirically with the same medications just in case.

A video of the TACE procedure can be viewed at http://www.amcny.org/node/341#Liver_Cancer/. For more case studies and to see how interventional radiology and interventional endoscopy can benefit patients, visit http://www.amcny.org/interventional-radiology-endoscopy/.

Dr. Berent is the director of Interventional Endoscopy Services in the Department of Diagnostic Imaging at The Animal Medical Center in New York City. Dr. Weisse is the director of Interventional Radiology Services in the Department of Diagnostic Imaging at The Animal Medical Center in New York City.

References

1. Llovet JM, Real MI, Montana X, et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet 2002;359(9319):1734-1739.

2. Lo CM, Ngan H, Tso WK, et al. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology 2002;35(5):1164-1171.

3. Varela M, Real MI, Burrel M, et al. Chemoembolization of hepatocellular carcinoma with drug eluting beads: efficacy and doxorubicin pharmacokinetics. J Hepatol 2007;46(3):474-481.

4. Lammer J, Malagari K, Vogl T, et al. Prospective randomized study of doxorubicin-eluting-bead embolization in the treatment of hepatocellular carcinoma: results of the PRECISION V study. Cardiovasc Intervent Radiol 2010;33(1):41-52.

Suggested Reading

• Dyet J, Ettles D, Nicholson A, et al. Textbook of endovascular procedures. 1st ed. Philadelphia, Pa: Churchill Livingstone, 2000;357-367.
• Weisse C, Clifford CA, Holt D, et al. Percutaneous arterial embolization and chemoembolization for treatment of benign and malignant tumors in three dogs and a goat. J Am Vet Med Assoc 2002;221(10):1430-1436.
• Soulen MC. Multimodality image-guided therapy for liver tumors, in Proceedings. Soc Interventional Radiol Annual Meeting, 2003;14(2):P211-P217.
• Hemingway AP, Allison DJ. Complications of embolization: analysis of 410 procedures. Radiology 1988;166(3):669-672.
• Geschwind JH. Therapy for liver cancer by targeting energy metabolism, in Proceedings. Soc Interventional Radiol Annual Meeting, 2003;14(2):P207-P211.