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Hepatic chemoembolization, also known as transarterial chemoembolization (TACE), is a minimally invasive treatment used for primary liver carcinomas and liver metastases, which involves delivering chemotherapy directly into the arteries feeding a liver tumor and may also be combined with particles that block the tumor's blood supply, thereby enhancing the anticancer effect and limiting systemic toxicity. TACE is typically considered when surgery or ablation is not viable, either due to tumor burden or the patient's overall condition. While it does not cure liver cancer, TACE may extend survival, downstage tumors for potential surgery or transplant, or serve as palliative care. Hepatic chemoembolization is technically successful in over 98% of cases and is one of several arterial-directed therapies for treating cancer that either began in or has metastasized to the liver. This course explores this procedure's complexities, including the indications, contraindications, and technique involved. This activity is designed to enhance the learner's competence in differentiating this technique from other treatment modalities, identifying patient selection factors, performing this procedure, and implementing an appropriate interprofessional approach when employing hepatic chemoembolization. Objectives: Identify appropriate candidates for hepatic chemoembolization based on tumor staging, liver function, and performance status to ensure optimal treatment outcomes. Determine the optimal timing for transarterial chemoembolization within the patient’s treatment plan by evaluating disease progression and response to prior therapies to maximize therapeutic benefits. Assess post-procedural complications of hepatic chemoembolization, such as post-embolization syndrome or liver failure, to guide timely management and follow-up care. Apply interprofessional team strategies to improve care coordination and outcomes in patients undergoing hepatic chemoembolization. Access free multiple choice questions on this topic.

Chemoembolization is a technique that involves injecting medication into the feeding arteries of a tumor or the injection of particles designed to slow or stop the arterial supply of oxygen and nutrients to that tumor.[1][2] Hepatic chemoembolization, a procedure that has been performed since the late 1970s, is one of several techniques used to treat either primary liver cancer or cancer metastatic to the liver. The most common primary liver cancer is hepatocellular carcinoma. Common types of liver metastases include those from the colon, breast, carcinoid, muscle sarcomas, and melanoma. Arterial chemoembolization can also be termed transarterial chemoembolization, a method of arterial-directed therapy (ADT). Other ADT methods include: Injection of particles alone without chemotherapy, called transarterial embolization or bland embolization Injection of radioactive particles without chemotherapy, called transarterial radioembolization, or occasionally referred to as the radioactive particle used, eg, Yttrium-90 (Y-90)

Significant complications occur in approximately 5 to 10 out of 100 people who undergo TACE.[20] The most common major complications include: Liver failure Death from any cause Abscess Besides these complications, other major complications have included: Tumor rupture Cholecystitis Biloma Permanent biliary stricture Arterial dissection Pulmonary emboli Tissue injury from nontarget embolization, with sequelae (eg, gastrointestinal hemorrhage) [21][22][23]

Effective delivery of hepatic chemoembolization requires a highly coordinated interprofessional team approach to ensure optimal patient-centered care, safety, and outcomes. Clinicians, including interventional radiologists, medical, surgical, and radiation oncologists, transplant surgeons, and nurses, must collaboratively evaluate the patient’s clinical profile and cancer stage to determine the appropriateness of hepatic chemoembolization. Strategic decision-making includes assessing tumor burden, liver function, and the potential for curative or palliative outcomes. Pharmacists play a crucial role in preparing chemotherapeutic agents and monitoring drug interactions or toxicity, while nurses provide essential peri-procedural support, education, and monitoring for complications. Hepatologists and primary care clinicians help manage underlying liver disease and comorbidities, supporting treatment readiness and recovery. Interprofessional communication and care coordination are vital in reducing postprocedure complications and enhancing patient outcomes. Timely and clear communication among all healthcare professionals ensures seamless transitions across care settings and promotes consistency in follow-up plans. A designated healthcare professional, often a nurse navigator or advanced clinician, should serve as the central point of contact for the patient, helping to interpret treatment recommendations, schedule follow-up care, and respond to emerging concerns. This centralized role improves team performance, minimizes delays in care, and fosters trust, empowering patients to actively participate in their treatment journey.