TACE intervention – a non-surgical treatment option for patients with intermediate to advanced liver cancer

      Primary liver cancer (PLC) is one of the most common malignancies, 90% of which are hepatocellular carcinoma (HCC), or hepatocellular carcinoma. The incidence of primary liver cancer ranks fifth among all malignant tumors and the mortality rate ranks third worldwide. China is the country with the highest incidence of hepatocellular carcinoma, accounting for about 50% of the global total, and occupies the second place in the mortality rate of malignant tumors in China. Hepatocellular liver cancer usually has no typical clinical manifestation in early stage, once patients show symptoms such as pain in the liver area, most of them are already in the middle and late stage, and about 70% of the liver cancers found clinically are in the middle and late stage. More than 90% of the blood supply of hepatocellular carcinoma tissue comes from hepatic artery, and portal vein only participates in a small amount of blood supply in the peripheral parts of tumor and envelope. The main mechanism is to introduce embolic agent into the tumor through catheter to block the blood supply from hepatic artery to the tumor, so that the cancer cells will die of ischemia and hypoxia; at the same time, chemotherapeutic drugs will be injected to “kill” the cancer cells. Hepatic artery chemoembolization significantly improves the prognosis of non-surgical patients, increases survival, and prolongs survival to some extent.       However, during conventional TACE interventions, incomplete deposition of iodinated oil is often encountered and tumors tend to grow from this area after surgery. In order to overcome this phenomenon, the “new sandwich” embolization method has been developed. This method uses a multiple combination of emulsion and granular material to achieve uniform (especially in the portal area) and complete embolization without increasing the amount of iodinated oil. After the super-selective cannula is in place, 1/2 to 2/3 of the total amount of the formulated emulsion is injected first, so that it (the first injected emulsion) is deposited in the peripheral part of the tumor, and then the solid granular embolic agent is injected at this time. The method can alternate between iodinated oil emulsion and solid embolic pellets depending on the situation, until the deposition of iodinated oil in the vascular zone stops in the blood supply artery. This method can reduce the incidence of “residual phenomenon” and increase the rate of tumor necrosis, thus improving the efficacy of hepatic artery chemoembolization. As with conventional embolization methods, the “new sandwich” embolization therapy has not been associated with any serious complications related to embolization methods after clinical follow-up, and its therapeutic safety is comparable. Figure 1, the first TACE showed abundant blood vessels. Figure 2: Complete disappearance of tumor vessels after embolization with the “new sandwich” embolization method. Figure 3: The tumor was sparsely vascularized at the time of TACE again. Figure 4: Complete disappearance of tumor vessels after applying the “new sandwich embolization method”.