Trans Arterial Chemo Embolisation (TACE) is a treatment for Hepatocellular Carcinoma (HCC) where an anticancer agent is mixed with an embolic agent and delivered via the hepatic artery. Early studies showed improved survival rates for TACE-treated HCC patients compared to controls. Patient selection is important, as TACE is best for patients with preserved liver function. More recently, techniques have improved such as using drug-eluting beads and performing highly selective TACE of tumor-feeding arteries to minimize liver damage while maximizing tumor exposure. Ongoing research continues to refine TACE as a key treatment option for HCC.

1. Trans Arterial Chemo Embolisation for
HepatoCellulare Carcinoma
EUROPEAN UNIVERSITARY DIPLOMA
HEPATIC-PANCREATIC AND BILIARY CANCER
15 December 2014
Dr.Y AJAVON and Pr. M LEWIN
Department of Interventionnal Radiology
Dr Sameh AWAD

2. Principle of TACE
HCC
5%
Portal vein
95 %
Hepatic Artery
Normal Liver
75%
Portal vein
25 %
Hepatic Artery

3. Digestive arteries

4. 1- T cœliaque
2- A Gastriqie Gauche
3- A Splenique
4- A Gastro-épiploique D et G
5- A Hépatique moyenne
(commune)
1
2
3
56
7
8
9
10
11
6- A Gastro-duodénale
7- A Hépatique propre
8- Branche droite de l’AH
9- Sectorielle postérieure (Seg 6
et 7)
10 - Sectorielle antérieure (seg 5 et 8)
11- Branche du seg 4
12- Branche gauche de l’AH (seg 2 et 3)
13- A Gastrique droite (pyélorique)
12
Estomac
13
4

5. Anatomical variant

6. Anti-cancer Agent
- Whether an anticancer agent is indispensable for
embolization and if so which agent is the best if needed, is
still controversial.
- (doxorubicin (36%) cisplatin (31%) epirubicin (12%)

8. Doyon : Hepatic arterial embolisation for the treatement
du HCC, Ann Radiol 1974
Vetter: 30 Patients: 1 year survival 59% vs 0 for controls,
3 Child C deceased. » Hepatology 1991
Bismuth: 291 patients: 2 year survival Child A 49%
3 months mortality in 37% with Child C.Am J Surg 1992
First experience of TACE in EU

9. Yamada et al. 120 patients de multinodulaires HCC,
survival at one year : - 44% for TACE , 28% for surgery
Radiologie 1983.
Okamura J. 13 patients before resection: complete
necrosis in 8 , Gan To Kagaku Ryoho, 1983
Ohnishi K. 20 patients of whom 16 had a tumor response
>50%,– 1 year survival 38% in 11 patients w.o. PVT,
Radiology, 1984
First experience of TACE in ASIA

10. The disaster

23. What are the lessons

24. J Bruix, Hepatology 2011
Patients selection

25. Takayasu et al, Jpn J Clin Oncol 2012
30% of patients 50% of patients
Patients selection

26. Patients selection
Takayasu et al, Jpn J Clin Oncol 2012

27. CASE 1: Conventionnal TACE of whole liver for HCC right
liver (male of 47 years with alcolic cirrhosis.
a
d
c
e f
b

28. CT after one month

29. CASE 2 :
- woman of 62 years with cirrhosis viral C, Child A
- TIPS for recurrance UDH
- Smalle HCC of 3 cm in segment 8

30. Hyper selective TACE of segment 8

31. CT after one month
Befor TACE

32. DC Beads

33. Nodule 1
du secteur latéral droit
Nodule 2
du dôme hépatique
CASE 3: selective TACE with DC Beads for tow HCC (man,
77 years old with cirrhosis C Chil B.
MRI befor TACE

34. (N1)
(N2)
MRI after one month

35. Be careful
Bilary injury with non selectif TACE with DC Beads
(CT after one month)

36. Be careful
Dont do portal embolization early after TACE

37. TACE for HCC in 2014

46. Japonais experience with lipiodol

59. M
ERCI