Clinical

Transarterial chemoembolization shrinks liver metastases

Last Updated: 2003-10-30 11:06:49 -0400 (Reuters Health)

By Will Boggs, MD

NEW YORK (Reuters Health) - Transarterial chemoembolization (TACE) can be used to shrink liver tumors in preparation for laser-induced thermotherapy (LITT) for patients with unresectable liver metastases that are too large for LITT alone, according to a report in the November issue of Radiology.

The rationale behind TACE is that the blood supply to most hepatic tumors originates from the hepatic artery, the authors explain, whereas the portal vein predominantly supplies blood to normal liver parenchyma.

Dr. Thomas J. Vogl and colleagues from University Hospital Frankfurt, Germany, used repeated TACE of the hepatic artery before LITT in 162 patients with unresectable liver metastases.

Patients received an average of 5.5 TACE procedures, the authors report, and 82 of the patients experienced a decrease in the size of the treated lesions averaging 35%.

MR imaging of the remaining patients showed stable disease in 47 patients and progressive disease in 33 patients.

The overall cumulative survival after the first course of TACE was 17.0 months, the researchers note, whereas the cumulative survival among the 82 patients whose tumor shrinkage allowed LITT was 24.9 months.

Patients with fewer lesions, smaller diameter lesions, or higher vascularization had better responses to the combined therapy, the report indicates.

There were no fatal or major complications from TACE, the investigators report, and only one major complication occurred within 30 days of LITT (a death likely resulting from sepsis in a 73-year-old patient).

"Even in large liver metastases, locoregional chemotherapy provides an approach to control the disease under certain circumstances," Dr. Vogl told Reuters Health. "Our current data support the idea that this approach is best for colorectal carcinoma and breast cancer metastases."

"Intervals of 3 to 4 weeks between the TACE cycles seems appropriate," Dr. Vogl added.

Radiology 2003;229:457-464.