Transarterial chemoembolization (TACE) is an effective palliative, sometimes even potentially healing (curative) type of treatment for neuroendocrine liver metastases. TACE can get rid of symptoms which cannot be controlled otherwise, i.e. hypoglycemia in metastatic insulinoma. In addition, TACE effectively reduces the neuroendocrine tumor load in the liver.
Chemoembolization is a local treatment method which combines two methods – embolization and chemotherapy. The interventional radiologist inserts a catheter from the groin to the main liver artery. The main liver artery branches off into smaller arteries in the liver. Each of the liver metastases is supplied with blood through one or more of these smaller arteries. During chemoembolization small plastic particles are delivered through the catheter to the vessels that supply the neuroendocrine metastasis. Thereby the vessels are blocked and blood supply of the metastasis is stopped. The neuroendocrine tumor cells in this area die off due to the lack of nutrients and oxygen. Often a cytostatic drug is also injected through the catheter and thus placed directly at the metastasis ("localized chemotherapy"). The chemotherapeutic (cytostatic) agent kills cancer cells, too. However, there is no agreement on whether the additional local injection of a chemotherapeutic (cytostatic) drug significantly increases the cancer-killing effects of the embolizing plastic particles. If no cytostatic drug is applied, the procedure is called transarterial embolization (TAE).
Transarterial (chemo) embolization can be used in combination with other treatment modalities as to further increase the overall effectiveness. TACE is usually carried out in several sessions separated by six to eight weeks.
Transarterial embolization of a neuroendocrine liver metastasis. The left-hand image shows the findings before, and the right-hand image the findings after the embolization ("obstruction") of the blood vessel supplying the metastasis (see red arrow).