Hepatic artery embolization

Hepatic artery embolization, also known as trans-arterial embolization (TAE), is one of the several therapeutic methods to treat primary liver tumors or metastases to the liver. The embolization therapy can reduce the size of the tumor, and decrease the tumor's impact such its hormone production, effectively decreasing symptoms. The treatment was initially developed in the early 1970s.[1] The several types of hepatic artery treatments are based on the observation that tumor cells get nearly all their nutrients from the hepatic artery, while the normal cells of the liver get about 70-80 percent of their nutrients and 50% their oxygen supply from the portal vein, and thus can survive with the hepatic artery effectively blocked.[2] In practice, hepatic artery embolization occludes the blood flow to the tumors,[3] achieving significant tumor shrinkage in over 80% of people.[3] Shrinkage rates vary.[4][5]

Hepatic artery embolization
Other namesHAE, trans-arterial embolization, TAE
Specialtyinterventional radiology/oncology

Background

The several types of hepatic artery treatments are based on the observation that tumor cells get nearly all their nutrients from the hepatic artery, while the normal cells of the liver get about 70-80 percent of their nutrients and 50% their oxygen supply from the portal vein, and thus can survive with the hepatic artery effectively blocked.[2] In practice, hepatic artery embolization is an option if the neoplastic growth is mainly within the liver.[6] By occluding the blood supply to the tumors,[3] achieving significant tumor shrinkage in over 80% of people.[3] Shrinkage rates vary.[4] The therapy can effectively decrease symptoms by reducing the size of the tumor, or by decreasing the tumor's impact, for example by decreasing the tumor's production of hormones.[7]

Primary liver tumors, metastatic neuroendocrine tumors to the liver[8] and other metastases to the liver[9][10] may be considered for therapy directed via the hepatic artery.

Method
Main article: Embolization

The percutaneous Seldinger technique introduces a catheter, which is a thin flexible tube made of medical grade material, into the hepatic artery under radiological control.[11][12] This approach was developed for metastatic neuroendocrine tumors in the early 1970s.[1] Tumor cells get over 90% of their nutrients from the hepatic artery,[1] while the normal cells of the liver get about 70-80 percent of their nutrients and 50% their oxygen supply from the portal vein, and thus can survive with the hepatic artery effectively blocked.[1][2] Once the catheter is carefully placed in the artery or in a selected branch, the blood flow can be occluded by injecting various items, such as plastic particles, glue, metal coils, foam, or by deploying a balloon.[11] Additional considerations and procedural details have been reviewed.[1][13]

In hepatic artery chemotherapy (HAC), chemotherapy agents are given into the hepatic artery, often by steady infusion over hours or even days. Compared with systemic chemotherapy, a higher proportion of the chemotherapy agents is (in theory) delivered to the lesions in the liver.[14][15]

Hepatic artery chemoembolization (HACE), sometimes called transarterial chemoembolization (TACE), combines hepatic artery embolization with hepatic artery chemo infusion. In one method, embospheres bound with chemotherapy agents injected into the hepatic artery, lodge in downstream capillaries. The spheres not only block blood flow to the lesions but by halting the chemotherapy agents in the neighborhood of the lesions, they provide a much better targeting leverage than chemo infusion provides.

See also

References
  1. Del Prete, Michela; Fiore, Francesco; Modica, Roberta; Marotta, Vincenzo; Marciello, Francesca; Ramundo, Valeria; Di Sarno, Antonella; Carratù, Annachiara; Di Roseto, Chiara; Tafuto, Salvatore; Tatangelo, Fabiana; Baldelli, Robero; Colao, Annamaria; Faggiano, Antongiulio (2014). "Hepatic arterial embolization in patients with neuroendocrine tumors". Journal of Experimental & Clinical Cancer Research. 33: 43. doi:10.1186/1756-9966-33-43. PMC 4038067. PMID 24887262.
  2. Pommier R. 2003. The role of surgery and chemoembolization in the management of carcinoid. California Carcinoid Fighters Conference. October 25, http://www.carcinoid.org/content/role-surgery-and-chemoembolization-management-carcinoid
  3. Kvols LK. 2002. Carcinoid Tumors and the Carcinoid Syndrome: What's New in the Therapeutic Pipeline. (The Carcinoid Cancer Foundation: Carcinoid Symposium 2002)http://www.carcinoid.org/content/carcinoid-tumors-and-carcinoid-syndrome-whats-new-therapeutic-pipeline
  4. Gu, Ping; Wu, Jennifer; Newman, Elliot; Muggia, Franco (2012). "Treatment of Liver Metastases in Patients with Neuroendocrine Tumors of Gastroesophageal and Pancreatic Origin". International Journal of Hepatology. 2012: 1–8. doi:10.1155/2012/131659. PMC 3299245. PMID 22518318.
  5. Lewis, M. A; Jaramillo, S; Roberts, L; Fleming, C. J; Rubin, J; Grothey, A (2012). "Hepatic Artery Embolization for Neuroendocrine Tumors: Postprocedural Management and Complications". The Oncologist. 17 (5): 725–31. doi:10.1634/theoncologist.2011-0372. PMC 3360912. PMID 22511263.
  6. Chan, Jennifer A; Kulke, Matthew H (2011). "New Treatment Options for Patients with Advanced Neuroendocrine Tumors". Current Treatment Options in Oncology. 12 (2): 136–48. doi:10.1007/s11864-011-0148-2. PMID 21437592. S2CID 40007214.
  7. Strosberg, J. R; Choi, J; Cantor, A. B; Kvols, L. K (2006). "Selective hepatic artery embolization for treatment of patients with metastatic carcinoid and pancreatic endocrine tumors" (PDF). Cancer Control. 13 (1): 72–8. doi:10.1177/107327480601300110. PMID 16508629.
  8. Castellano, Daniel; Grande, Enrique; Valle, Juan; Capdevila, Jaume; Reidy-Lagunes, Diane; o'Connor, Juan Manuel; Raymond, Eric (2014). "Expert consensus for the management of advanced or metastatic pancreatic neuroendocrine and carcinoid tumors". Cancer Chemotherapy and Pharmacology. 75 (6): 1099–114. doi:10.1007/s00280-014-2642-2. PMID 25480314. S2CID 39434924.
  9. Swierz, Mateusz J.; Storman, Dawid; Riemsma, Robert P.; Wolff, Robert; Mitus, Jerzy W.; Pedziwiatr, Michal; Kleijnen, Jos; Bala, Malgorzata M. (12 March 2020). "Transarterial (chemo)embolisation versus no intervention or placebo for liver metastases". The Cochrane Database of Systematic Reviews. 3: CD009498. doi:10.1002/14651858.CD009498.pub4. ISSN 1469-493X. PMC 7066934. PMID 32163181.
  10. Lodh, Suhrid; Maher, Richard; Guminski, Alexander (2014). "Intra-arterial infusion and chemo-embolization for melanoma liver metastases". Journal of Surgical Oncology. 109 (4): 376–82. doi:10.1002/jso.23551. PMID 24500702.
  11. MedlinePlus. Endovascular embolization. MedlinePlus, a service of the U.S. National Library of Medicine
  12. Catheter Embolization. Radiological Society of North America and American College of Radiology
  13. Brown, Daniel B; Cardella, John F; Sacks, David; Goldberg, S. Nahum; Gervais, Debra A; Rajan, Dheeraj K; Vedantham, Suresh; Miller, Donald L; Brountzos, Elias N; Grassi, Clement J; Towbin, Richard B (2009). "Quality Improvement Guidelines for Transhepatic Arterial Chemoembolization, Embolization, and Chemotherapeutic Infusion for Hepatic Malignancy". Journal of Vascular and Interventional Radiology. 20 (7): S219–S226, S226.e1–10. doi:10.1016/j.jvir.2009.04.033. PMID 19560002.
  14. Fong, T and Schoenfield LJ. Arterial Chemotherapy Infusion of the Liver (and) Chemoembolization of the Liver (TACE)).
  15. Leal, Julie N; Kingham, T. Peter (2015). "Hepatic Artery Infusion Chemotherapy for Liver Malignancy". Surgical Oncology Clinics of North America. 24 (1): 121–48. doi:10.1016/j.soc.2014.09.005. PMID 25444472.
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