Transcatheter hepatic artery chemoembolization for primary liver cancer

Primary liver cancer is one of the common malignant tumors in China with high mortality rate. Although surgical resection is the best treatment, the surgical resection rate is less than 30% so far, and due to the insidious onset, most patients are unresectable at the time of diagnosis. At this time, palliative treatments become an important means of treating primary liver cancer. Transcatheter arterial chemoembolization (TACE) has been clinically used for nearly 30 years and has become one of the life-saving palliative therapies. TACE is performed using the Seldinger method of percutaneous arterial puncture, a catheter sheath is placed using a guide wire, and then cannulation is performed under X-ray television fluoroscopy. Arteriography is performed after selective insertion of the catheter into the tumor supplying artery to understand the distribution of the supplying artery and tumor vessels, and chemotherapeutic drugs or embolic drugs are infused via the catheter. TACE has the following antitumor effects: First, the antitumor effect of hepatic artery embolization. First, the anti-tumor effect of hepatic artery embolization. 25% of normal liver blood supply comes from hepatic artery and 75% from portal vein, and a large amount of clinical angiographic data shows that almost all primary liver cancers are hepatic artery blood supply. After hepatic artery embolization, tumor necrosis occurs due to ischemia, while normal liver tissues are less affected because of the blood supply from portal vein. Secondly, the antitumor effect of hepatic artery infusion chemotherapy. It can increase the local drug concentration in the liver relative to intravenous chemotherapy and reduce systemic toxicity. Third, the targeting effect of super-liquidated iodine oil. It can selectively transport chemotherapeutic drugs to tumor tissues, which not only increases the drug content in tumor tissues, but also prolongs the drug action time after it is fully mixed with chemotherapeutic drugs to make emulsion via hepatic artery injection. Fourth, the synergistic effect of embolization and chemotherapy. On the one hand, the tumor is more sensitive to the cytotoxic effect of anticancer drugs under hypoxic condition after embolization. On the other hand, embolization restricts or blocks the flushing effect of hepatic artery blood to iodine oil, which slows down the release of anticancer drugs from iodine oil and prolongs the action time of chemotherapeutic drugs even more. Due to the biological characteristic that primary hepatocellular carcinoma is prone to intrahepatic metastasis, the extent of liver resection is limited by cirrhosis and adjacent important structures, and the recurrence rate after surgery is high. Postoperative adjuvant TACE can reduce the postoperative recurrence rate, while postoperative adjuvant TACE treatment also facilitates the early detection of small recurrent lesions.