Transcatheter arterial chemoembolization: Technique and future potential

Transcatheter arterial chemoembolization (TACE) is one of the most commonly performed procedures in interventional radiology and over the past 20 years, has significantly contributed to the evolution of this subspecialty (1, 2). TACE exploits the initial observation that most hepatic malignancies receive their blood supply largely by the hepatic artery, and selectively delivers intra-arterially high doses of chemotherapy to the tumor bed, while sparing the surrounding hepatic parenchyma (3, 4). Despite its promising design, TACE has not proved yet to be as effective as in theory. Several variations in the application of the technique, as well as the heterogeneity of chemotherapeutic regimens, are some of the most important challenges toward a thorough investigation of its clinical benefits (5). It is therefore essential for interventional radiologists to standardize the technique in order to maximize its effectiveness and help future advancements. In this chapter, we review the technical and clinical part of the procedure, as well as current results and future potential of TACE. Definition of Tace, Historical Background and Underlying Principles of Tumor Damage: TACE is defined as the infusion of a mixture of chemotherapeutic agents with or without iodized oil followed by embolization with particles (6). The technique was introduced in 1977 by Yamada, who intra-arterially delivered gelatin-sponge pieces permeated with 10 mg of mitomycin C or 20 mg of doxorubicin (Adriamycin), after super-selecting the tumor feeding artery of unresectable hepatomas (3, 4).