Hepatocellular carcinoma is a blood-rich tumor, with more than 90% of its blood supply originating from the hepatic artery.
Interventional treatment of hepatocellular carcinoma
In primary hepatocellular carcinoma, the diseased tissue is primarily supplied by the hepatic artery, so an interventional cannula can be placed in the hepatic artery supplying the tumor to infuse chemotherapeutic agents and perform embolization.
There are two aspects to its treatment rationale:
- Embolization, in which the vessels supplying the tumor are blocked with iodine oil or other embolic agents, making it difficult for the tumor cells to be nourished;
- Infusion, in which tumor cells are killed by chemotherapy drugs.
Embolization of the tumor-supplying artery with an embolic agent that incorporates chemotherapeutic agents is called transcatheter arterial chemoembolization (TACE).
TACE is the preferred method of nonsurgical treatment for patients with intermediate to advanced disease who cannot be surgically resected and who are unable or unwilling to undergo surgery for other reasons.
Procedure of liver cancer intervention
The first step
A catheter sheath is placed by puncture in the femoral artery, after which the catheter is inserted into the abdominal trunk or the common hepatic artery for imaging, and the location, size, and number of intrahepatic tumors and the blood supply to the tumor are clarified based on the hepatic arteriogram images.
Step 2
Insert the arteries of the liver lobe or segment to instill chemotherapeutic drugs, mainly platinum and anthracyclines. Each drug needs to be diluted with saline or 5% glucose solution and slowly injected into the target vessel.
Step 3
Selective or superselective insertion into the target artery supplying the liver tumor and selection of the appropriate embolic agent. Generally, super-liquidated iodine oil is used to fully mix with chemotherapeutic drugs to form an emulsion, which is slowly injected through the catheter to block the tumor blood supply artery and cause ischemic necrosis of the tumor.
The amount of iodine oil depends on the size of the tumor and the blood supply to the tumor. Other embolic agents include gelatin sponges, PVA microspheres, anhydrous ethanol, etc.
Advantages of interventional therapy for hepatocellular carcinoma
Interventional therapy has the following advantages over general chemotherapy:
- More direct: the treatment principle is to inject chemotherapy drugs directly into the blood supply vessels of the tumor;
- More concentrated: chemotherapy drugs first enter the tumor locally and then are carried to other parts of the body through the bloodstream;
- More durable: some chemotherapeutic drugs mixed with iodine oil are more likely to stay in the tumor for a longer time and exert anti-tumor effects;
- Better effect: the effect is better than systemic chemotherapy due to the high concentration and long duration of the drug entering the tumor.