[1] The rationale for the use of bland embolization for hepatocellular carcinoma (HCC) and/or other hyper-vascular tumors is based on the fact that a normal liver receives a dual blood supply from the hepatic artery (25%) and the portal vein (75%).
[5] A meta-analysis was performed of randomized controlled trials comparing the survival rates after TACE or TAE, which failed to demonstrate any significant difference between bland or chemoembolization.
[7] A single blinded control trial compared the outcomes of TAE and DEB-TACE in a total of 101 patients with unresectable Okuda stage I or II HCC.
[9] The most common indication of this therapy is for treatment of unresectable primary hepatocellular carcinoma, based on anatomic distribution of disease, vascular invasion, underlying hepatic function or a combination of these factors.
The Child-Pugh nominal liver staging system is the most accurate in predicting survival of patients with unresectable HCC treated with TACE and TAE.
[citation needed] When evaluating a patient for embolization, both the severity of the underlying liver disease and the extent of the tumor being treated may be considered.
Patients with hepatic metastatic disease from neuroendocrine tumors, gastrointestinal stromal tumors and other sarcomas, ocular melanoma, and some "hypervascular" metastases (such as those from breast cancer or renal cell cancer) may also be candidates for bland embolization, assuming the liver is the only site of disease, or when the procedure is being performed for palliation of symptoms.
[citation needed] Intra-arterial therapy based on ischemia induced by terminal vessel blockage should not be expected to be efficacious in patients with hypovascular tumors and has no proven role in the treatment of typical metastatic adenocarcinoma from most gastrointestinal malignancies.
Triple-phase CT is essential for documenting the extent of disease, demonstrating arterial anatomy, evaluating the portal venous system, and looking for non-hepatic blood supply to the tumor.
When appropriate, angiography of non-hepatic vessels potentially supplying the tumor (e.g. phrenic, internal mammary or intercostal arteries) is performed.
Despite the larger sphere size, the fact that the microspheres were spherical and hydrophilic meant they did not "clump" like PVA and were capable of penetrating more distally into the terminal vasculature.
[citation needed] Similar to transarterial chemoembolization (TACE), postembolization syndrome is one of the most common side effects of bland embolization.
[17] Non-target embolization is one of the most dreaded complications of hepatic embolotherapy but occurs infrequently when strict attention is paid to arterial anatomy.
Follow-up triple phase CT is performed 2 to 4 weeks after treatment is complete and reviewed for any evidence of persistent untreated disease.