Chemoembolization

The transarterial chemoembolization (TACE) is the therapeutic measure that combines two mechanisms of action – local introduction of the chemotherapeutic agent and blockage of the artery that feeds the tumor with emboli. The procedure is effective in tumors with active vascularization, i.e. in the primary and metastatic liver cancer, breast cancer, lung cancer and other types of oncology. Despite being minimally invasive, chemoembolization is carried out in the Departments of Interventional Radiology, by healthcare professionals with qualifications in this sphere. Cost of treatment in leading hospitals corresponds with its clinical efficacy. The cost of embolization or chemoembolization for different cancer types (liver cancer, renal cell cancer, breast cancer, cervical cancer, colon cancer, lung cancer, ovarian cancer, rectal cancer, etc.) is between 24,500 EUR and 41,200 EUR.

Content

1. Chemoembolization in hepatocellular carcinomas
2. Chemoembolization in other types of cancer
3. How the chemoembolization is carried out
4. Results and benefits of the chemoembolization
5. Where to undergo chemoembolization

Chemoembolization in hepatocellular carcinomas

First, chemoembolization was implemented into the clinical practice for the treatment of intermediate or advanced stage hepatocellular carcinoma. Before implementation of this method, only palliative treatment options were available for the patients with such stages of liver cancer. Patients were treated with symptomatic medicines and their life expectancy was under 20 months. With transarterial chemoembolization, life expectancy extends significantly.

Patients with both primary hepatocellular carcinoma and metastatic liver lesions are eligible for the procedure. Metastases from colorectal tumors, sarcomas, and even ocular melanoma can be detected here as the systemic circulation carries all the blood through the liver for the detoxification.

However, in particular liver conditions patients are treated with chemoembolization with certain precautions. These are liver cirrhosis, blockage of the portal vein or bile ducts, extensive tumor spreading throughout the organ, and numerous extra-hepatic metastases. Thus, before admitting to the hospital’s Department of Interventional Radiology for performing the procedure a patient undergoes obligatory examination. After assessing the information about the patient's health, a doctor prescribes the procedure or recommends to choose another therapeutic option.

Chemoembolization in other types of cancer

Another sphere of medicine where TACE is used is breast cancer treatment. In this case TACE mostly serves as the regional chemotherapy, as the systemic chemotherapy for breast cancer is often associated with severe side effects. Before performing chemoembolization, a doctor collects the information about the number and location of arteries that feed the tumor, as the individual and age-related variability of the breast arteries is often present.

The selective chemoembolization of lung cancer is the suitable treatment for lung metastases, and for the primary lung tumor (non‐small cell lung cancer). TACE demonstrates efficacy in the presence of mediastinal, pleural, endobronchial and lung metastatic foci. In addition, it treats tumors that respond poorly or are not responding at all to systemic chemotherapy, as well as cannot be destroyed by means of resection, ablation or even stereotactic body radiation therapy. In particular patients, TACE (which is called TPCE, transpulmonary chemoembolization, in this case) is used for making the primary tumor more resectable. In other patients it may be used as the palliative therapeutic option.

Due to the peculiarities of blood supply, TACE is also carried out in women with cervical cancer. The procedure is efficient in locally advanced tumors that have not spread the metastases to lymph nodes or distant organs. Uterine artery chemoembolization (UACE) reduces the tumor volume and facilitates the subsequent surgery. For achieving better effect, in certain hospitals it can be followed by preoperative radiation therapy.

The information about the role of TACE in the treatment of other cancers is limited. Nevertheless, particular clinical trials and case reports specify its administration in patients with pancreatic cancer, sarcomas of bones and soft tissues, and neuroendocrine tumors (NETs).

How the chemoembolization is carried out

The procedure starts from introducing a small flexible catheter into the femoral artery. Being moved slowly along the blood vessel under visual guidance (fluoroscopic or tomographic one), a catheter reaches the target area (uterine artery, pulmonary artery, liver artery, etc.). 

After that, high dosage of the chemotherapeutic agent is injected through the catheter. The chemotherapeutic drug is selected individually, considering tumor type and its susceptibility. For instance, doxorubicin or cisplatin are mainly used in patients with liver malignancies, women with cervical cancer are treated with carboplatin, etc. After the drug introduction, the artery is blocked with an embolus, so that the drug stays inside the tumor and does not enter the systemic blood circulation.

In the interventional radiology hospitals, two types of emboli are used:

1. Mixture of a chemotherapeutic drug and lipiodol. Lipiodol is a hydrophobic substance that forms blocking spheres inside the blood vessels.
2. Embolic drug-eluting beads. These are microspheres with better pharmacokinetic profile. In using these occluding agents, the chemotherapeutic drug is released slowly, which contributes to long-lasting antitumor effect.

Results and benefits of the chemoembolization

Due to the double mechanism of action, high selectivity, and minimal invasiveness, chemoembolization is characterized by:

1. Good tolerance, there is no need for long-term recovery (as the procedure does not require thoracotomy or other invasive interventions).
2. Administration of higher doses of chemotherapeutic drugs as compared to the conventional systemic chemotherapy.
3. Absence of typical for the systemic chemotherapy side effects.
4. High efficacy, even in tumors that are resistant to the systemic chemotherapy, do not respond to stereotactic body radiation therapy and are inoperable.
5. Efficacy in tumors of any size, including unresectable neoplasms; possibility of tumor shrinkage and its subsequent surgical removing.
6. Possibility of combining with other therapeutic options, such as tumor ablation or radiation therapy.

In most cases, TACE itself is not the curative procedure, but it is included in modern treatment protocols of leading hospitals as it is able to extend life expectancy and provide patients with symptoms improvement.

Where to undergo chemoembolization

Regardless of the tumor type, chemoembolization is performed in the Departments of Interventional Radiology, after the obligatory preliminary examination and consultations with healthcare professionals. Many cancer patients do not have this innovative and high-technology treatment option in their native countries. Such patients may receive medical services in hospitals abroad with the help of Booking Health.

On the Booking Health website patients can find reliable and detailed information about hospitals and doctors that specialize in TACE, cost of treatment and prices for related services, available appointments, etc. As prices in the different hospitals may differ significantly, a patient may compare the cost of treatment in few suitable healthcare facilities and choose the most favourable price.

Booking Health specialists guide the patient during all stages of trip and undergoing medical program:

• Choosing the hospital based on its specialization and success rates
• Establishing communication with your doctor, elaborating the preliminary medical program for undergoing TACE
• Providing favorable cost of treatment, without additional coefficients for foreign patients (saving up to 50%)
• Booking the appointment on the necessary date
• Monitoring of the medical program by independent Booking Health specialists
• Communication with the hospital after TACE completion
• Control of invoices and return of unspent funds
• Organization of additional examinations after TACE completion
• Booking accommodation and airline tickets, transfer organization
• Services of interpreter

To start planning your treatment, please, leave the request on the Booking Health website. A patient case manager or medical advisor will contact you the same day to discuss the TACE procedure.

Authors: 

The article was edited by medical experts, board-certified doctors Dr. Vadim Zhiliuk and Dr. Nadezhda Ivanisova. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!

Sources:

National Cancer Institute

European Society for Medical Oncology

Healthline