Chemoembolization in the Management of Liver Tumors

Abstract

Learning Objectives: After completing this course, the reader will be able to: Explain the anatomic and biologic rationale for using chemoembolization to treat tumors localized to the liver. Identify appropriate candidates for this treatment based upon tumor biology and patient characteristics. Anticipate and manage the toxicities and complications of chemoembolization. Discuss the variability in results reported in the literature from different centers and in different tumor types. Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.com The dual vascular supply of the liver affords a unique opportunity to explore intraarterial therapies for hepatic malignancies. Chemoembolization is a well-established technique combining intra-arterial chemotherapy with delivery of embolic agents in order to achieve an antitumor effect due to a high local concentration and prolonged dwell time of the drug, along with select ischemia. Many tumors, such as hepatocellular carcinoma, colorectal cancer, and neuroendocrine tumors, cause symptoms and death by local growth and destruction of the liver. While there are other methods capable of controlling small or isolated hepatic neoplasms, none are suitable for the majority of these patients. Chemoembolization can produce significant results in terms of tumor shrinkage in many of these patients, and there are studies to suggest a survival advantage in hepatocellular carcinoma. Toxicity, however, may be substantial, and patient selection is crucial in order to achieve the optimal benefit of this powerful technique for individual populations.