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Double CT scan:
Response of massive HCC to chemoembolization (Top: before treatment; bottom: after treatment).
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Chemoembolization is the process of injecting chemotherapy drugs into the hepatic artery that supplies blood to the tumor
in the liver. The artery is then often embolized – or blocked off – with tiny particles. This has the added benefit of depriving
the tumor of its blood supply. Commonly used chemotherapy drugs for HCC are Cisplatin, Carboplatinum, Oxaliplatin, Gemcitabine,
Doxorubicin and occasionally Mitomycin C. For CCC, Gemcitabine and Cisplatin is most commonly used. For neuroendocrine cancers,
we use Streptozotocin and Doxorubicin.
The liver is unique in that it has two blood supplies – an artery (the hepatic artery) and a large vein (the portal vein).
The portal vein provides about 75 percent of the liver’s blood; the hepatic artery contributes only 25 percent. However, the
hepatic artery is almost exclusively the source of blood for liver tumors. By blocking the hepatic artery, it’s possible to
deprive the tumor of oxygen and nutrients – while the liver continues to be supplied with blood from the portal vein.
Another advantage of embolization: no blood washes through the tumor, so drugs stay in the tumor for a much longer time –
up to one month, in fact. Since the chemotherapeutic drugs are injected directly at the tumor site, dosages 20 to 200 times
greater than standard chemotherapy are injected into a vein in the arm. The drugs are then “trapped” in the liver and do not
circulate throughout the body. This helps spare most healthy liver tissue and reduces overall side effects.
A celiac angiogram showing the blood vessels of the liver with multiple HCC tumors before (left) and after (right) treatment
showing loss of vascularity and response to therapy.
Candidates for intrahepatic chemotherapy/chemoembolization
While this treatment has little or no effect on cancers in other parts of the body, it is ideally suited for both primary
and secondary liver cancers, including:
Ideal candidates for this procedure have cancer confined to the liver, minimal ascites (accumulation of fluid in the abdominal
cavity), and a bilirubin of less than 3.0 mg/dl.
The procedure
In preparation for the procedure, do not eat or drink the night before. The next morning at the hospital, you will receive
an IV line that administers antibiotics and other medications.
A radiologist will then place a small catheter in an artery in the groin for an arteriogram will be performed, which will
specifically look at the liver’s arteries. Following identification of these arteries, the catheter will be directed into
the branch of the artery that supplies blood to the tumor. The chemoembolization mixture will then be injected.
After this is complete, you will return to your room to lie flat in bed for about six hours. You will receive more IV fluids
overnight. Most of the time, patients are discharged from the hospital the next day.
The most common side effects of chemoembolization are pain, fever and nausea. Although these symptoms may vary in intensity,
they usually last only a few hours to a few days. Medications are available to minimize these side effects. Some people also
notice slight hair loss.
Although there is a small risk of liver failure or infection, serious complications from chemoembolization are rare.
Your team of Liver Tumor Program doctors at the Kimmel Cancer Center at Jefferson will help determine if chemotherapy/chemoembolization
is a viable treatment option for you.
Contact us
To schedule an appointment with a Jefferson physician call 1-800-JEFF-NOW or click here.
To contact the Liver Tumor Program team at the Kimmel Cancer Center at Jefferson, please call 215-503-8752 and/or fax your records to 215-503-8755. We aim to schedule your first clinic visit within two weeks of your diagnosis being made and records being received.
