Background and aims: Transarterial chemoembolization (TACE) is a loco-regional therapy performed to treat tumors in the liver. The branch of the hepatic artery supplying the tumor is catheterized and a mixture of  iodized oil, chemotheraputic agents and PVA embolic materials  infused. TACE is a palliative treatment of unresectable cancer in the liver but can also be employed as adjunctive therapy to liver resection and/or radiofrequency ablation. The procedure can in certain instances downstage the disease and provide a bridge to liver transplantation. The aim of this study was to evaluate outcome in patients that have undergone loco-regional therapy in Iceland and the frequency and severity of complications related to the procedure.

Material and methods: All Icelandic patients that had undergone TACE, transarterial chemotherapy or bland embolization of liver tumors between 1 May 2007 and 1 March 2011 were included in the study.

Results:Eighteen TACE, six transarterial chemotherapy treatments and two bland embolizations were performed on nine patients withhepatocellular carcinoma (HCC), and three patients with carcinoid metastases in the liver. Mean-survival of patients with HCC was 15.2 months. Survival of patients with carcinoid metastases was between 61 and 180 months. Complete response was achieved twice and partial response four times. The disease remained stable after eleven procedures but progressed after three procedures. Minor complications were diagnosed in 6 of 26 procedures and one major complication. No patient suffered from liver failure due to the procedure. Of the 9 HCC patients, 1 patient was on the liver transplant list before TACE and later underwent successful transplantation. Additionally, 3 of the remaining 8 patients were downstaged and put on  to the transplant list.

Bjarnason ThA¹, Bjarnason H^1,2 , Bergmann OM^1,3, Thorisson HM^1,4,5

¹Faculty of Medicine, Univerity of Iceland, ²Department of Radiology, Mayo Clinic, Rochester MN, ³Department of Gastro-enterology and ⁴Department of Radiology, Landspítali – University Hospital. ⁵Yale School of Medicine, New Haven CT

 

Table III.
IKSS = Transarterial chemoembilization, CLIP = Cancer of the Liver Italian Program Classification, MELD = Model for End-stage Liver Disease, KK = Male, KVK = Female, HCC = Hepatocellular carcinoma, cHCC-CC = Combined hepatocellular cholangiocarcinoma, HCV = Hepatitis C virus, PBC = Primary billiary cirrhosis, Á.e.v = does not apply, ÓM = undectable.

Table IV.
MELD = Model for End-stage Liver Diesease

Table V.
PFS = Progression free survival, AS = Complete respons, HS = Partial response, SS = Stable disease, VS = progressive disease, EE = no follow-up, Á.e.v. = does not apply. *Months, ¹Bland embolization, ²Transarterial chemotherapy

Table VI.
SS = Stable disease, VS = Progressive disease, EE = No follow-up. * Months, ¹Bland embolization.

 

Fig1. Hepatocellular carcinoma treated with TACE:

53 year old male with a large tumor in the liver which shows contrast enhancement on T1 weighted MRI (fig. 1a) that underwent TACE. Digital subtraction angiography shows blood flow  from branches of the right hepatic artery (fig. 1b). The feeding branches were catheterized with a microcatheter (fig. 1c) and treated with cheom-emolization. MRI four weeks after intervention shows almost no contrast enhancement in the tumor on T1 weighted MRI (fig. 1d)