Patient preparation before the procedure

Before the procedure, an office consultation with the interventional radiologist is carried out to evaluate the patient for the procedure.

During the initial visit, a complete history of the patient is taken where details of all medications including any herbal medications are registered. The doctor may also perform some tests (if required) to check allergy to any medication especially local anesthetic, general anesthesia, or contrast materials as well as tests to check the kidney function and determine if the blood is clotting normally are carried out to ensure the post-procedure survival of the patient

The patient may also be asked to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), or blood thinners if needed.

Females should always inform the doctor or the technologist about their pregnancy. Doctors cannot perform several tests on a pregnant lady because the primary goal is to avoid the fetus's exposure to radiation. If an x-ray is compulsory, the doctor will ensure all the precautions to reduce the radiation exposure to the fetus.

How is TACE performed?

Transarterial chemoembolization or TACE is a minimally invasive non-surgical procedure performed by a specially trained interventional radiologist in a radiology room.

Imaging tests like a CT scan or an MRI with contrast is performed before starting the procedure to map the path of the blood vessels that feed the tumor.

The patient is then given an injection of Allopurinol to protect the kidneys from chemotherapy as well as from the byproducts produced by the dying tumor cells.

The procedure is usually performed under moderate sedation, local anesthesia, or in some rare cases general anesthesia. Once the patient is sedated, the doctor makes a minimal skin incision  (mostly in the groin or in the wrist) through which a thin catheter is inserted into the artery and advanced to the tumor site where anti-cancer drugs are then released through the catheter once it is positioned in the branches of the artery feeding the tumor. Once the chemotherapeutic agent is completely injected, the doctor then embolise the feeding arteries.

Once the procedure is completed, the doctor removes the catheter and applies some pressure on the artery to stop the bleeding or may use a closure device to seal the puncture in the artery. It allows the patient to move around more quickly, and no stitches are visible on the skin.
The tiny opening in the skin is covered using a dressing.

Transarterial chemoembolization (TACE) is usually completed within 90 minutes but depending on which artery was accessed and if a closure device was used, the patient can expect to stay in the recovery room for 2-6 hours and can be discharged from the hospital in 1-2 days.

The patient is then given some antibiotics to prevent any infection and may also be given some medication to stop nausea and pain.

Follow Up

After the procedure, the patient is scheduled for an additional CT or MRI scan as well as blood tests to determine whether the procedure was successful or not.

Benefits of TACE

• TACE can be repeated if cancer starts to regrow.
• It can be combined with other therapies like tumor ablation, chemotherapy, or radiation.
• It can be used for tumors that are non-resectable
• It can be used for tumors that are difficult to reach.
• It improves the function of the organ

Risks Factors

Any procedure that includes penetration through the skin or in blood vessels includes some risks. The risk associated with TACE are:

• Infection
• Bruising at the site of puncture of the vessel
• Bleeding from the vessels
• Allergic reaction to the contrast material
• Kidney damage in patients with diabetes or other pre-existing kidney diseases
• Thrombosis especially in children

All of the above-mentioned risks are rare and can be avoided with proper pre and post-surgical care

Side effects

TACE is a safe procedure that does not include any severe side effects but still some side effects that are associated with the procedure are:

• Nausea
• Thrombocytopenia (Reduction in number of platelets)
• Leukopenia (Reduction in number of platelets)
• Anemia (Reduction in Hemoglobin)

All of the above-mentioned side effects are rare and can be avoided with proper pre and post-surgical care

Prognosis:

Keep in mind that Transarterial chemoembolization is a treatment and not a cure.
Almost 70% of the patients will witness a reduction in the size of tumors and improvement in the function of the organ as well as improved quality of life and survival rates, depending on the type of cancer.

Statistics:

In about two-thirds of cases treated till now, TACE stopped tumors from spreading and caused them to shrink. The benefit lasted for an average of 10 to 14 months depending on the type of tumor

Cost of TACE in Germany

Transarterial chemoembolization or TACE costs vary depending on the tumor size, location, number, and the number of sessions needed.

In Germany, the cost of Transarterial chemoembolization in specialized hospitals ranges between 3,500-6,000 € per session. This amount covers the cost of the initial clinical and laboratory examination, pre-therapy CT scan, Transarterial chemoembolization procedure itself, the follow-up CT scan, and the elaboration of recommendations for future treatment.