Liver Embolization

The Division of Interventional Radiology is proud to provide arterial embolization services, including TACE and Y-90, for treatment of liver cancer for the Southcoast Hospital System.

Introduction to Liver Cancer

Liver cancer can be primary or secondary.
Primary liver cancer originates within the liver (examples include hepatocellular carcinoma and cholangiocarcinoma).
Secondary liver cancer spreads to the liver (metastasizes) from another part of the body (such as from colon/rectal cancer, breast cancer, skin cancer, kidney cancer, lung cancer, etc.).

Liver Cancer Treatment Options

The treatment options for liver cancer include surgical resection, liver transplantation, thermal ablation, arterial embolization, radiation therapy, and systemic therapy.
These treatment options can be used alone or in combination depending on the clinical situation.
Individual treatment plans are determined by a multidisciplinary team of physicians on a case-by-case basis.
The following is an overview of the two types of arterial embolization procedures that are used for treatment of liver cancer, including TACE and Y-90, which are performed by interventional radiologists.

What is an Interventional Radiologist? (learn more)

Interventional Radiologists (IR doctors) are physicians who perform minimally-invasive procedures in nearly every organ system of the body using ultrasound, x-ray, CT, or MRI guidance.
By performing procedures in the least invasive way possible, interventional radiologists can diagnose, treat, and even cure disease while minimizing the risk to the patient and improving health outcomes with less pain and shorter recovery times in comparison to open surgery.
Most procedures can be performed without the need for general anesthesia or admission to the hospital.

TACE (Trans-Arterial Chemo-Embolization)

TACE is a minimally-invasive image-guided method of treating liver tumors that involves blocking the blood supply to the tumor, which kills it by depriving it of oxygen and nutrients.

How is TACE performed?

The procedure itself is not significantly painful and is performed with sedation medicine rather than general anesthesia (no breathing tube).
The procedure is performed by inserting a small catheter/tube into the artery in either the groin or the wrist and advancing it to the blood vessel in the liver that supplies the tumor.
Once the catheter is in position, the blood vessel is blocked (embolized) by injecting small particles/ beads through the catheter that are coated with a chemotherapy agent called Doxorubicin, which also helps to kill the tumor.

Recovery after TACE

Patients are sometimes discharged home on the day of the procedure; however, most are observed overnight for pain and nausea management.
As the tumor degenerates, inflammatory mediators are released that can cause a variety of symptoms known as post-embolization syndrome (PES).
PES symptoms include pain, nausea, vomiting, fever, and malaise.
These symptoms typically peak in 12-24 hours and resolve within 5-7 days.

Y-90 (Yttrium-90) Radioembolization

Y-90 is minimally-invasive image-guided method of treating liver tumors that is very similar to TACE.
The main difference is that the particles in Y-90 are smaller than the ones used in TACE and they contain a radioactive substance called Yttrium-90 instead of a chemotherapy agent.
Because the particle size is smaller in Y-90, patients tend to experience less PES symptoms than with TACE.

How is Y-90 performed?

Y-90 treatment is very similar to TACE; however, Y-90 patients must have two procedures, one for planning and one for treatment.
The planning procedure is necessary because Y-90 can have an affect on lung function.
Before Y-90 treatment, a test dose is administered during a separate planning procedure in order to estimate how much Y-90 would go to the lungs.

What is better TACE or Y-90?

The determination of which procedure is most appropriate depends on the patient’s overall health status as well as the size, number, and location of the lesions being treated.
Y-90 and TACE are both typically performed on patients with intermediate stage disease and the goal is usually palliative.
The hope is to eradicate as much of the tumor as possible while preserving the normal liver so that patients can live as long and as comfortably as possible.

Arterial Embolization for Liver Cancer