Early stage hepatocellular carcinoma is mainly treated by surgical resection, however, the onset of hepatocellular carcinoma is insidious and its malignancy is high, and patients are mostly in the middle and late stages when they are diagnosed. With the development of vascular interventional radiology, transcatheter hepatic artery chemoembolization (TACE), as the main method, has become the first choice of non-surgical treatment for hepatocellular carcinoma.
TACE is to selectively insert the blood supply artery of hepatocellular carcinoma through femoral artery cannula for embolization and infusion of chemotherapeutic drugs to embolize the main tumor vessels in order to block the blood supply of tumor to cause ischemic necrosis and infuse chemotherapeutic drugs to kill tumor cells. Advantages: less invasive, less side effects, can be repeatedly treated, improve survival quality and prolong life. The efficacy of chemoembolization combined with radiofrequency ablation in early-stage hepatocellular liver cancer has shown that patients’ long-term survival and disease-free survival are similar to that of surgical resection alone.
TACE combined with other treatments has the potential to be an alternative treatment to surgery, bringing new hope for patients with unresectable tumors.
I. Rationale.
The growth of tumor depends on the formation of tumor neovascularization. tACE, as an important method of clinical treatment for liver cancer, mainly blocks the blood supply of tumor by embolizing the blood supply artery of tumor, resulting in tumor ischemia and hypoxia, to achieve the purpose of inhibiting tumor growth and promoting tumor cell necrosis and apoptosis.
Since 95%-99% of blood supply of hepatocellular carcinoma comes from hepatic artery, 25%-30% of blood supply of normal liver tissue comes from hepatic artery, while 70%-75% comes from portal vein, embolization of hepatic artery can effectively block the blood supply of tumor and make it shrink and necrotic, while it has less effect on the blood vessels of liver tissue. It can improve the local drug concentration of the tumor and reduce the toxic side effects of the drug on the whole body.
II. Indications.
Applicable to primary hepatocellular carcinoma and postoperative recurrence of hepatocellular carcinoma (liver function Child grade A, B-grade).
Operation method.
Percutaneous arterial puncture is used to place the catheter sheath using a short guidewire, and then the cannulation operation is performed under X-ray fluoroscopy. After inserting the catheter selectively into the tumor blood supply artery, arteriography is performed to understand the distribution of the blood supply artery and tumor vessels. Transcatheter infusion of chemotherapeutic drugs or embolic drugs. The more widely used embolic agents in arterial embolization therapy are iodinated oil emulsion, gelatin sponge, PVA (polyvinyl alcohol) granules, drug microspheres, etc. After the treatment, the tube is removed, the puncture site is compressed to stop bleeding, and the limb on the puncture side is braked for 12 hours and lies flat for 24 hours to prevent bleeding and hematoma formation at the puncture site.
IV. Interventional efficacy of hepatocellular carcinoma.
It is mainly related to the malignancy degree and biological behavior of the primary tumor. The survival period of untreated middle and late stage liver cancer is 3-6 months; interventional treatment enables patients to survive with tumor, and literature reports that the survival period of middle and late stage liver cancer can be significantly prolonged after interventional treatment.
V. Factors affecting prognosis.
1.Tumor blood supply: the richer the blood supply, the better the curative effect;
2.Tumor envelope: those with envelope will have good curative effect;
3. The lighter the cirrhosis, the better the outcome; the better the outcome for those without arteriovenous fistula; the better the outcome for those without ascites;
4.Elderly people have better results than younger people;
5, cheerful personality, strong will, and appropriate rest is good.
Sixth, the timing of treatment selection.
1.The interval cycle should be decided according to specific conditions, such as: tumor size, iodine oil aggregation, liver function changes, blood picture and general condition. Generally, it can be repeated once every 4-6 weeks. One embolization for middle and advanced hepatocellular carcinoma cannot completely control the tumor growth, so two or more TACE and/or other therapies combined are needed.
2. Basic conditions for choosing re-treatment: previous treatment is effective; the mass is shrinking; AFP level is still high or elevated; imaging shows that there are still lesions not filled with iodine oil or there are new lesions; liver function is normal or mildly abnormal, and it is estimated that those can receive re-treatment. The general principle is to minimize the number of treatments while keeping the tumor under control and surviving with tumor, in order to improve the patient’s survival quality and reduce the economic burden.
There are reports from home and abroad that individual patients have survived for more than 10 years after (TACE) treatment.