Skip to main content
Log in

Transcatheter Arterial Chemoembolization for Liver Cancer: Is It Time to Distinguish Conventional from Drug-Eluting Chemoembolization?

  • Review
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Conventional transcatheter arterial chemoembolization and chemoembolization with drug-eluting beads are increasingly being performed interchangeably in many institutions throughout the world. As both therapies continue to being tested in many phase II and III studies and in combination with other therapies, especially targeted agents, for treatment of primary and metastatic liver cancer, it is imperative to review their current status and evaluate their impact on patient survival. This review critically assesses patient selection, indications, contraindications, techniques, materials, safety, and clinical outcomes of patients treated with conventional chemoembolization and chemoembolization with drug-eluting beads.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Roche A, Girish B, de Baere T et al (2003) Trans-catheter arterial chemoembolization as first-line treatment for hepatic metastases from endocrine tumors. Eur Radiol 13:136

    PubMed  Google Scholar 

  2. Stuart K (2003) Chemoembolization in the management of liver tumors. Oncologist 8:425–437

    Article  PubMed  Google Scholar 

  3. Geschwind JFH (2002) Chemoembolization for hepatocellular carcinoma: where does the truth lie? J Vasc Interv Radiol 13:991–994

    Article  PubMed  Google Scholar 

  4. Aoki T, Imamura H, Hasegawa K et al (2004) Sequential preoperative arterial and portal venous embolizations in patients with hepatocellular carcinoma. Arch Surg 139:766–774

    Article  PubMed  Google Scholar 

  5. Arii S, Yamaoka Y, Futagawa S et al (2000) Results of surgical and nonsurgical treatment for small-sized hepatocellular carcinomas: a retrospective and nationwide survey in Japan. The Liver Cancer Study Group of Japan. Hepatology 32:1224–1229

    Article  CAS  PubMed  Google Scholar 

  6. Livraghi T, Meloni F, Morabito A et al (2004) Multimodal image-guided tailored therapy of early and intermediate hepatocellular carcinoma: long-term survival in the experience of a single radiologic referral center. Liver Transpl 10(2 suppl 1):S98–S106

    Article  PubMed  Google Scholar 

  7. Peng ZW, Chen MS, Liang HH et al (2010) A case-control study comparing percutaneous radiofrequency ablation alone or combined with transcatheter arterial chemoembolization for hepatocellular carcinoma. Eur J Surg Oncol 36:257–263

    PubMed  Google Scholar 

  8. Shibata T, Isoda H, Hirokawa Y et al (2009) Small hepatocellular carcinoma: is radiofrequency ablation combined with transcatheter arterial chemoembolization more effective than radiofrequency ablation alone for treatment? Radiology 252:905–913

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  10. Veltri A, Moretto P, Doriguzzi A et al (2006) Radiofrequency thermal ablation (RFA) after transarterial chemoembolization (TACE) as a combined therapy for unresectable non-early hepatocellular carcinoma (HCC). Eur Radiol 16:661–669

    Article  PubMed  Google Scholar 

  11. Burger I, Hong K, Schulick R et al (2005) Transcatheter arterial chemoembolization in unresectable cholangiocarcinoma: initial experience in a single institution. J Vasc Interv Radiol 16:353–361

    PubMed  Google Scholar 

  12. Buijs M, Kamel IR, Vossen JA et al (2007) Assessment of metastatic breast cancer response to chemoembolization with contrast agent enhanced and diffusion-weighted MR imaging. J Vasc Interv Radiol 18:957–963

    Article  PubMed  Google Scholar 

  13. Liapi E, Geschwind JF, Vossen JA et al (2008) Functional MRI evaluation of tumor response in patients with neuroendocrine hepatic metastasis treated with transcatheter arterial chemoembolization. AJR Am J Roentgenol 190:67–73

    Article  PubMed  Google Scholar 

  14. Vogl TJ, Gruber T, Balzer JO et al (2009) Repeated transarterial chemoembolization in the treatment of liver metastases of colorectal cancer: prospective study. Radiology 250:281–289

    Article  PubMed  Google Scholar 

  15. Vogl TJ, Naguib NN, Nour-Eldin NE et al (2010) Transarterial chemoembolization (TACE) with mitomycin C and gemcitabine for liver metastases in breast cancer. Eur Radiol 20:173–180

    Article  PubMed  Google Scholar 

  16. Vossen JA, Kamel IR, Buijs M et al (2008) Role of functional magnetic resonance imaging in assessing metastatic leiomyosarcoma response to chemoembolization. J Comput Assist Tomogr 32(3):347–352

    Article  PubMed  Google Scholar 

  17. Aliberti C, Tilli M, Benea G, Fiorentini G (2006) Trans-arterial chemoembolization (TACE) of liver metastases from colorectal cancer using irinotecan-eluting beads: preliminary results. Anticancer Res 26(5B):3793–3795

    CAS  PubMed  Google Scholar 

  18. de Baere T, Deschamps F, Teriitheau C et al (2008) Transarterial chemoembolization of liver metastases from well differentiated gastroenteropancreatic endocrine tumors with doxorubicin-eluting beads: preliminary results. J Vasc Interv Radiol 19:855–861

    Article  PubMed  Google Scholar 

  19. Forner A, Ayuso C, Varela M et al (2009) Evaluation of tumor response after locoregional therapies in hepatocellular carcinoma: are response evaluation criteria in solid tumors reliable? Cancer 115:616–623

    Article  PubMed  Google Scholar 

  20. Lammer J, Malagari K, Vogl T et al (2009) Prospective randomized study of doxorubicin-eluting-bead embolization in the treatment of hepatocellular carcinoma: results of the PRECISION V study. Cardiovasc Intervent Radiol 33(1):41–52

    Article  PubMed  Google Scholar 

  21. Malagari K, Chatzimichael K, Alexopoulou E et al (2008) Transarterial chemoembolization of unresectable hepatocellular carcinoma with drug eluting beads: results of an open-label study of 62 patients. Cardiovasc Intervent Radiol 31:269–280

    Article  PubMed  Google Scholar 

  22. Martin RC, Robbins K, Tomalty D et al (2009) Transarterial chemoembolisation (TACE) using irinotecan-loaded beads for the treatment of unresectable metastases to the liver in patients with colorectal cancer: an interim report. World J Surg Oncol 7:80

    Article  PubMed  Google Scholar 

  23. Reyes DK, Vossen JA, Kamel IR et al (2009) Single-center phase II trial of transarterial chemoembolization with drug-eluting beads for patients with unresectable hepatocellular carcinoma: initial experience in the United States. Cancer J 15:526–532

    Article  CAS  PubMed  Google Scholar 

  24. Georgiades CS, Liapi E, Frangakis C et al (2006) Prognostic accuracy of 12 liver staging systems in patients with unresectable hepatocellular carcinoma treated with transarterial chemoembolization. J Vasc Interv Radiol 17:1619–1624

    Article  PubMed  Google Scholar 

  25. Huo TI, Lee PC, Huang YH et al (2006) The sequential changes of the model for end-stage liver disease score correlate with the severity of liver cirrhosis in patients with hepatocellular carcinoma undergoing locoregional therapy. J Clin Gastroenterol 40:543–550

    Article  PubMed  Google Scholar 

  26. Georgiades CS, Hong K, D’Angelo et al (2005) Safety and efficacy of transarterial chemoembolization in patients with unresectable hepatocellular carcinoma and portal vein thrombosis. J Vasc Interv Radiol 16:1653–1659

    PubMed  Google Scholar 

  27. Okamura J, Kawai S, Ogawa M et al (1992) Prospective and randomized clinical trial for the treatment of hepatocellular carcinoma: a comparison of L-TAE with Farmorubicin and L-TAE with Adriamycin (second cooperative study). Cancer Chemother Pharmacol (Historical Archive) 31:S20

  28. Geschwind JF, Ramsey DE, van der Wal BC et al (2003) Transcatheter arterial chemoembolization of liver tumors: effects of embolization protocol on injectable volume of chemotherapy and subsequent arterial patency. Cardiovasc Intervent Radiol 26:111–117

    Article  PubMed  Google Scholar 

  29. Bhattacharya S, Dhillon AP, Winslet MC et al (1996) Human liver cancer cells and endothelial cells incorporate iodised oil. Br J Cancer 73:877–881

    CAS  PubMed  Google Scholar 

  30. Bhattacharya S, Novell JR, Winslet MC, Hobbs KE (1994) Iodized oil in the treatment of hepatocellular carcinoma. Br J Surg 81:1563–1571

    Article  CAS  PubMed  Google Scholar 

  31. Terayama N, Matsui O, Gabata T et al (2001) Accumulation of iodized oil within the nonneoplastic liver adjacent to hepatocellular carcinoma via the drainage routes of the tumor after transcatheter arterial embolization. Cardiovasc Intervent Radiol 24:383–387

    Article  CAS  PubMed  Google Scholar 

  32. Tancredi T, McCuskey PA, Kan Z et al (1999) Changes in rat liver microcirculation after experimental hepatic arterial embolization: comparison of different embolic agents. Radiology 211:177–181

    CAS  PubMed  Google Scholar 

  33. Chung JW, Park JH, Han JK et al (1996) Hepatic tumors: predisposing factors for complications of transcatheter oily chemoembolization. Radiology 198:33–40

    CAS  PubMed  Google Scholar 

  34. Cheng HY, Shou Y, Wang X et al (2004) Adjustment of lipiodol dose according to tumor blood supply during transcatheter arterial chemoembolization for large hepatocellular carcinoma by multidetector helical CT. World J Gastroenterol 10:2753–2755

    PubMed  Google Scholar 

  35. Mondazzi L, Bottelli R, Brambilla G et al (1994) Transarterial oily chemoembolization for the treatment of hepatocellular carcinoma: a multivariate analysis of prognostic factors. Hepatology 19:1115–1123

    Article  CAS  PubMed  Google Scholar 

  36. Nakao N, Uchida H, Kamino K et al (1992) Effectiveness of lipiodol in transcatheter arterial embolization of hepatocellular carcinoma. Cancer Chemother Pharmacol 31(suppl):S72–S76

    Article  PubMed  Google Scholar 

  37. Tadavarthy SM, Knight L, Ovitt TW et al (1974) Therapeutic transcatheter arterial embolization. Radiology 112:13–16

    CAS  PubMed  Google Scholar 

  38. Link DP, Strandberg JD, Virmani R et al (1996) Histopathologic appearance of arterial occlusions with hydrogel and polyvinyl alcohol embolic material in domestic swine. J Vasc Interv Radiol 7:897–905

    Article  CAS  PubMed  Google Scholar 

  39. Hong K, Kobeiter H, Georgiades CS et al (2005) Effects of the type of embolization particles on carboplatin concentration in liver tumors after transcatheter arterial chemoembolization in a rabbit model of liver cancer. J Vasc Interv Radiol 16:1711–1717

    PubMed  Google Scholar 

  40. Laurent A (2007) Microspheres and nonspherical particles for embolization. Tech Vasc Interv Radiol 10:248–256

    Article  CAS  PubMed  Google Scholar 

  41. Vallee J-N, Lo D, Guillevin R et al (2003) In vitro study of the compatibility of tris-acryl gelatin microspheres with various chemotherapeutic agents. J Vasc Interv Radiol 14:621–628

    PubMed  Google Scholar 

  42. Siskin GP, Dowling K, Virmani R et al (2003) Pathologic evaluation of a spherical polyvinyl alcohol embolic agent in a porcine renal model. J Vasc Interv Radiol 14:89–98

    PubMed  Google Scholar 

  43. Lewis AL, Gonzalez MV, Lloyd AW et al (2006) DC bead: in vitro characterization of a drug-delivery device for transarterial chemoembolization. J Vasc Interv Radiol 17:335–342

    Article  PubMed  Google Scholar 

  44. Lewis A, Gonzalez M, Leppard S et al (2007) Doxorubicin eluting beads. 1. Effects of drug loading on bead characteristics and drug distribution. J Mater Sci Mater Med 18:1691–1699

    Article  CAS  PubMed  Google Scholar 

  45. Lewis AL, Taylor RR, Hall B et al (2006) Pharmacokinetic and safety study of doxorubicin-eluting beads in a porcine model of hepatic arterial embolization. J Vasc Interv Radiol 17:1335–1343

    Article  PubMed  Google Scholar 

  46. Tang Y, Taylor RR, Gonzalez MV et al (2006) Evaluation of irinotecan drug-eluting beads: a new drug-device combination product for the chemoembolization of hepatic metastases. J Controlled Release 116:e55–e56

    Article  CAS  Google Scholar 

  47. Taylor RR, Tang Y, Gonzalez MV et al (2007) Irinotecan drug eluting beads for use in chemoembolization: in vitro and in vivo evaluation of drug release properties. Eur J Pharmaceut Sci 30:7–14

    Article  CAS  Google Scholar 

  48. de Luis E, Bilbao J, de Ciércoles J et al (2008) In vivo evaluation of a new embolic spherical particle (hepasphere) in a kidney animal model. Cardiovasc Intervent Radiol 31(2):367–376

    Article  PubMed  Google Scholar 

  49. Malagari K, Alexopoulou E, Chatzimichail K et al (2008) Transcatheter chemoembolization in the treatment of HCC in patients not eligible for curative treatments: midterm results of doxorubicin-loaded DC bead. Abdom Imaging 33:512–519

    Article  PubMed  Google Scholar 

  50. Poon RT, Tso WK, Pang RW et al (2007) A phase I/II trial of chemoembolization for hepatocellular carcinoma using a novel intra-arterial drug-eluting bead. Clin Gastroenterol Hepatol 5:1100–1108

    Article  CAS  PubMed  Google Scholar 

  51. Jaeger HJ, Mehring UM, Castaneda F et al (1996) Sequential transarterial chemoembolization for unresectable advanced hepatocellular carcinoma. Cardiovasc Intervent Radiol 19:388–396

    Article  CAS  PubMed  Google Scholar 

  52. Liapi E, Georgiades CC, Hong K et al (2007) Transcatheter arterial chemoembolization: current technique and future promise. Tech Vasc Interv Radiol 10:2–11

    Article  PubMed  Google Scholar 

  53. Geschwind JF, Khwaja A, Hong K (2005) New intraarterial drug delivery system: pharmacokinetics and tumor response in an animal model of liver cancer. In: 2005 ASCO annual meeting, Orlando, FL

  54. Leung DA, Goin JE, Sickles C et al (2001) Determinants of postembolization syndrome after hepatic chemoembolization. J Vasc Interv Radiol 12:321–326

    Article  CAS  PubMed  Google Scholar 

  55. Brown KT (2004) fatal pulmonary complications after arterial embolization with 40–120-μm tris-acryl gelatin microspheres. J Vasc Interv Radiol 15(2 Part 1):197–200

    Google Scholar 

  56. Miyayama S, Yamashiro M, Okuda M et al (2010) Main bile duct stricture occurring after transcatheter arterial chemoembolization for hepatocellular carcinoma. Cardiovasc Intervent Radiol. doi:10.1007/s00270-009-9781-6

  57. Yoo KM, Yoo BG, Kim KS et al (2004) Cerebral lipiodol embolism during transcatheter arterial chemoembolization. Neurology 63:181–183

    CAS  PubMed  Google Scholar 

  58. Bruix J, Llovet JM, Castells A et al (1998) Transarterial embolization versus symptomatic treatment in patients with advanced hepatocellular carcinoma: results of a randomized, controlled trial in a single institution. Hepatology (Baltimore) 27:1578–1583

    CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  61. Takayasu K, Arii S, Ikai I et al (2006) Prospective cohort study of transarterial chemoembolization for unresectable hepatocellular carcinoma in 8510 patients. Gastroenterology 131:461–469

    Article  CAS  PubMed  Google Scholar 

  62. Hong K, Liapi E, Georgiades CS, Geschwind JF (2005) Case-controlled comparison of a percutaneous collagen arteriotomy closure device versus manual compression after liver chemoembolization. J Vasc Interv Radiol 16:339–345

    CAS  PubMed  Google Scholar 

  63. Liapi E, Geschwind JF (2007) Transcatheter and ablative therapeutic approaches for solid malignancies. J Clin Oncol 25:978–986

    Article  PubMed  Google Scholar 

  64. Liapi E, Lee KH, Georgiades CC et al (2007) Drug-eluting particles for interventional pharmacology. Tech Vasc Interv Radiol 10:261–269

    Article  PubMed  Google Scholar 

  65. Gupta S, Johnson MM, Murthy R et al (2005) Hepatic arterial embolization and chemoembolization for the treatment of patients with metastatic neuroendocrine tumors: variables affecting response rates and survival. Cancer 104:1590–1602

    Article  PubMed  Google Scholar 

  66. Vogl TJ, Gruber T, Naguib NN et al (2009) Liver metastases of neuroendocrine tumors: treatment with hepatic transarterial chemotherapy using two therapeutic protocols. AJR Am J Roentgenol 193:941–947

    Article  PubMed  Google Scholar 

  67. Vogl TJ, Naguib NN, Zangos S et al (2009) Liver metastases of neuroendocrine carcinomas: interventional treatment via transarterial embolization, chemoembolization and thermal ablation. Eur J Radiol 72:517–528

    Article  PubMed  Google Scholar 

  68. Tellez C, Benson AB III, Lyster MT et al (1998) Phase II trial of chemoembolization for the treatment of metastatic colorectal carcinoma to the liver and review of the literature. Cancer 82:1250–1259

    Article  CAS  PubMed  Google Scholar 

  69. Geschwind J, Hong K, Georgiades C (2006) Utility of transcatheter arterial chemoembolization for liver dominant colorectal metastatic adenocarcinoma in the salvage setting. In: American Society of Clinical Oncology gastrointestinal cancers symposium, San Francisco, CA, 26–28 January 2006

  70. Giroux MF, Baum RA, Soulen MC (2004) Chemoembolization of liver metastasis from breast carcinoma. J Vasc Interv Radiol 15:289–291

    PubMed  Google Scholar 

  71. Rajan DK, Soulen MC, Clark TW et al (2001) Sarcomas metastatic to the liver: response and survival after cisplatin, doxorubicin, mitomycin-C, Ethiodol, and polyvinyl alcohol chemoembolization. J Vasc Interv Radiol 12(2):187–193

    Article  CAS  PubMed  Google Scholar 

  72. Lee KH, Liapi E, Ventura VP et al (2008) Evaluation of different calibrated spherical polyvinyl alcohol microspheres in transcatheter arterial chemoembolization: VX2 tumor model in rabbit liver. J Vasc Interv Radiol 19:1065–1069

    Article  PubMed  Google Scholar 

  73. Saluzzo CM, Vignali C, Nicolini A et al (2007) TACE with HepaSphere microspheres loaded with chemotherapeutic agent: early experience in Italy of a multi-centre study. In: WCIO 2007, Washington, DC

  74. Grosso M, Vignali C, Quaretti P et al (2008) Transarterial chemoembolization for hepatocellular carcinoma with drug-eluting microspheres: preliminary results from an Italian multicentre study. Cardiovasc Intervent Radiol 31:1141–1149

    Article  PubMed  Google Scholar 

  75. Camma C, Schepis F, Orlando A et al (2002) Transarterial chemoembolization for unresectable hepatocellular carcinoma: meta-analysis of randomized controlled trials. Radiology 224:47–54

    Article  PubMed  Google Scholar 

  76. Yuen MF, Chan AOO, Wong BCY et al (2003) Transarterial chemoembolization for inoperable, early stage hepatocellular carcinoma in patients with Child-Pugh grade A and B: results of a comparative study in 96 Chinese patients. Am J Gastroenterol 98:1181–1185

    PubMed  Google Scholar 

  77. Brown DB, Chapman WC, Cook RD et al (2008) Chemoembolization of hepatocellular carcinoma: patient status at presentation and outcome over 15 years at a single center. AJR Am J Roentgenol 190:608–615

    Article  PubMed  Google Scholar 

  78. Kettenbach J, Stadler A, Katzler IV et al (2008) Drug-loaded microspheres for the treatment of liver cancer: review of current results. Cardiovasc Intervent Radiol 31:468–476

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

Jean-Francois Geschwind: Consultancies in the last 3 years: BIOCOMPATIBLES, INC., BOSTON SCIENTIFIC, MDS NORDION, BIOSPHERE MEDICAL. Grants received in the last 3 years: GENENTECH, INC., BIOSPHERE MEDICAL, CONTEXTVISION, INC., BOSTON SCIENTIFIC. Patents received: 20100203110 Therapeutics for Cancer Using 3-Bromopyruvate and Other Selective Inhibitors of ATP Production 08-12-2010; 20100137434 Methods and compositions for administration of 3-halopyruvate and related compounds for the treatment of cancer 06-03-2010. Eleni Liapi: Employment: FEDERAL, THROUGH THE NIH T32 GRANT 5T32EB006351-02 (PI: DEAN. F. WONG).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jean-Francois H. Geschwind.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Liapi, E., Geschwind, JF.H. Transcatheter Arterial Chemoembolization for Liver Cancer: Is It Time to Distinguish Conventional from Drug-Eluting Chemoembolization?. Cardiovasc Intervent Radiol 34, 37–49 (2011). https://doi.org/10.1007/s00270-010-0012-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-010-0012-y

Keywords

Navigation