Chemoembolization is a non-surgical procedure used to treat inoperable liver cancer. Studies have shown that at least 70% of patients experience improvement after this procedure and the benefits generally last for 10-14 months.
- What is chemoembolization?
- Why is this treatment effective?
- Is chemoembolization done in conjunction with other therapies?
- Reasons for having chemoembolization
- Risks involved in the procedure
- Conditions to let us know about
- Insurance coverage
- Procedure locations
- To schedule your procedure
- Preparation guidelines
- What to expect during your procedure
- Recovering from the radioembolization procedure
- Follow-up after the procedure
- Consults. Referrals. Scheduling. Appointments.
This innovative procedure delivers chemotherapy directly to the liver tumor using a non-surgical, minimally invasive technique performed by an interventional radiologist. With chemoembolization, a catheter is inserted through a tiny puncture in the groin and threaded through the arteries until it reaches the hepatic artery.
The hepatic artery is one of two blood vessels that feed the liver and the one that usually supplies blood to the tumors. Once the catheter is properly placed in the hepatic artery, a chemotherapy drug and millions of tiny particles are released into the blood stream. The particles lodge into the smaller blood vessels that feed the tumor.
This treatment keeps the chemotherapy drugs in the liver longer than other approaches, allowing more time to kill adjacent cancer cells. The particles also prevent oxygen and nutrients from reaching the tumor, further contributing to the tumor’s shrinkage. Healthy liver tissue continues to get blood from the portal vein, so very little of it is damaged by the chemoembolization. Since the entire body is not exposed to the chemotherapy drug as it is with conventional chemotherapy, there is a lesser chance of side effects.
Additionally, this targeted approach allows a much more potent chemotherapy drug to be used. New innovations in particles, now called drug eluting beads, allow the chemotherapy to delivered directly into the tumor at high concentration with a slow release over 10 days to 2 weeks from one treatment session. The drug concentration can even be higher with less systemic side effects.
The liver processes and removes the chemotherapy drug over approximately a four-week period. The particles remain in the liver without causing any complications.
Depending on the type of cancer and number of tumors, chemoembolization may be used alone or in conjunction with another treatment, such as surgery, radiation or chemotherapy.
If there is a tumor in both lobes of the liver, you will need to have two treatments to treat each side separately, with at least one month between the treatments.
Chemoembolization is used to treat primary liver cancer and to treat metastases to the liver from tumors that originated elsewhere (for example, colon cancer to the liver) in patients who cannot have the tumors surgically removed. It may also be used to shrink tumors prior to surgery. Not everyone with inoperable liver cancer is a candidate for this procedure. If you are a candidate, your doctor may recommend this procedure over other non-surgical treatments for the following reasons:
- Treatment is regional (only affects the liver)
- Milder side effects
- Very short recovery
- Treats all tumors, including undetected tumors
- Can be repeated
- Results have been very promising
This minimally-invasive treatment generally has few side effects. It can be used to treat both primary and secondary liver cancer. While it won’t cure the cancer, it can shrink tumors, improve the quality of life, and possibly extend life for people with inoperable liver cancer.
Since a catheter is placed within the blood vessels, there is a risk of damage to a blood vessel, bruising or bleeding at the puncture site, or infection. You could have an allergic reaction to the contrast material used during the procedure. Most patients experience side effects after chemoembolization. These include pain, nausea, vomiting, and fever.
The chemotherapy drug rarely causes hair loss, decreases in white blood cells and platelets, and anemia. With newer drug eluting beads, these side effects are even more rare and recovery is even shorter.
Serious complications occur in 5% of cases and typically include liver infection or damage. Serious side effects are also possible in the gastrointestinal tract or lungs if the particles are not correctly placed in the liver. These are uncommon and usually only occur in patients who have unusual or severely damaged blood vessels in the liver.
Most patients remain in the hospital for 23 hours and are discharged the next day. Some patients receiving drug eluting beads can go home the same day.
In advance of your exam, you will have a consultation with the RIA Endovascular physician in the RIA Endovascular office before the outpatient hospital procedure. Please let your physician know if any of the following circumstances apply to you:
- Previous reaction to iodine
- Coagulation disorder
- Diabetes or kidney disease
- Currently pregnant or nursing
Chemoembolization is usually covered by insurance. Check with your insurance carrier to be sure. If you decide to undergo radioembolization, our dedicated in-house precertification specialist will help to get your procedure pre-authorized.
Consultations for chemoembolization of tumors are done at RIA Endovascular Clinic. The procedure is performed at the following Radiology Imaging Associates partner hospitals in the Denver, Colorado area:
To schedule a consultation to discuss chemoembolization of tumors, call 720-493-3406.
Following are the general preparation guidelines for chemoembolization. You may receive additional or differing guidelines based on your specific situation. Please contact us at 720-493-3406 if you have any questions.
- Stop taking blood-thinning medications 3-5 days before the procedure (contact your doctor first to ensure it’s safe).
- Do not eat or drink anything but clear liquids for 8 hours before the procedure; do not drink anything for 4 hours before the procedure.
- Prepare for an overnight stay in the hospital.
- Arrange for someone to drive you home from the procedure.
Before scheduling the procedure, a RIA Endovascular interventional radiologist must determine if you are a good candidate for chemoembolization. You or your doctor will need to supply us with medical records and test results so your eligibility can be determined. If you appear to be a candidate, you will undergo additional exams including a blood test and a CT scan. These exams will help the interventional radiologist confirm your eligibility for chemoembolization and determine an appropriate chemotherapy drug dose for your liver.
For the procedure, you will be asked to change into a gown. A nurse or technologist will start an intravenous (IV) line in your arm. You will receive antibiotics and other medication through the IV to prevent infection and protect your kidneys during the procedure. Before beginning the procedure, the technologist will set up various devices so your heart rate and blood pressure can be monitored throughout the procedure. You will remain awake for the procedure, but you will be given conscious sedation through the IV to help you relax and eliminate discomfort.
The site of the small groin incision will be cleansed. A fluoroscope will be moved into position above your abdomen. The radiologist will then make an incision approximately 2-3mm long and insert the catheter. While watching the fluoroscope images, he or she will carefully guide the catheter to the hepatic artery in the liver. After the catheter is properly placed near the tumor, the radiologist will deploy the chemotherapy drug and particles through the catheter and into the hepatic artery. After the entire dose has been deposited, the catheter will be withdrawn and the incision cleaned and taped.
This procedure is generally painless; however, some patients experience pain when the particles are deployed. Let the radiologist known immediately if you feel any pain. The procedure usually takes 2-3 hours. Patients generally spend one night in the hospital for observation and pain and nausea management; however, some may need to stay longer.
Most patients return to their normal activities within a week. Patients usually experience fatigue for 1-4 weeks following the therapeutic injection. Many patients may also experience a low-grade fever, loss of appetite, nausea, vomiting, or pain for up to a week. You will receive prescriptions for medication to control pain and nausea and an antibiotic to prevent infection. If your fever suddenly becomes higher or the intensity of your pain increases, contact RIA Endovascular Clinic and your oncologist.
You will have a CT or MRI scan 2 weeks to 3 months and a blood test within two weeks of the last procedure to determine how effective the treatment was. You will continue to have a CT or MRI scan every three months to check tumor shrinkage and look for new tumors. Alternatively, you may be followed with PET CT as well.