Transarterial chemoembolization of liver metastases: Indication, technique, results

We have analyzed the effectiveness of repetitive transarterial chemoembolization (TACE) of liver metastases as a neoadjuvant or palliative treatment modality in comparison with published data. Chernoembolization of liver metastases is performed with different cytotoxic drugs. In a 4-week interval, 357 patients were treated with repetitive 1,158 TACE courses performed with lipiodol, mitomycin C and spherex. 254 patients were treated palliatively, 18 patients symptomatically and 79 patients via the neoadjuvant protocol, 71 patients of whom received additional MR-guided laser-induced thermoablation (LITT) of the metastases after TACE. Our results were compared with the literature. Most of the patients with a low rate of local complications like vascular occlusion or liver abscess could be treated successfully using TACE. In 81% of the treated lesions a primary high lipiodol retention was observed. in the palliative group a reduction of the tumor size was noted in 36% of the lesions, a growth stop in 24% and a reduction of the tumor growth rate in 40%. In 70% of the patients treated neodadjuvantly a reduction of the tumor size was found. The median survival rate of our collective of patients with liver metastases averages 8.6 months. In the literature median survival rates in patients with liver metastases were between 8.5 and 23 months after TACE. TACE is judged as a minimal invasive and outpatient treatment protocol for liver metastases. A combination of TACE and different local treatment modalities presents a neoadjuvant treatment strategy to control the diseased liver.