Patient Selection Criteria
Chemoembolization is used most often in unresectable patients with tumors confined to the liver. Patients with severe hepatic dysfunction, compromised portal venous (liver vein) blood flow and/or biliary obstruction are not candidates.
Description of Procedure
This is a minimally invasive procedure, usually done in the interventional radiology department. General anesthesia is not required. The arteries supplying the tumor with blood are identified and a catheter is positioned into those selected vessels. An embolic agent is mixed with chemotherapeutic agent(s) and then infused through the catheter to the tumor site. The embolic agent is used to cut off the blood supply of the tumor (embolizing) so that the chemotherapy stays within the tumor area.
The success of the embolization is initially established by using contrast dye to confirm that blood flow to the tumor has been cut off (ischemia), while flow to normal arteries is preserved.
The 30-day mortality rate for chemoembolization ranges from 1 to 4%.
The most common complications for chemoembolization are:
- Abdominal pain
- Fever greater than 39 degrees C (102.2 degrees F)
Less common complications include, but are not limited to:
- Transient renal insufficiency
- Transient encephalopathy
- Ulnar neuropathy
- Hepatic failure
- Hepatic infarction
- Biliary necrosis
- Hepatic abscess
- Tumor rupture
- Surgical cholecystitis
- Embolism to the gut
Recovery Time/ Lifestyle Changes
The average length of hospital stay for chemoembolization is 1.5 days. If there are many tumors or the tumors are large, multiple treatments will have to be done, requiring the patient return for subsequent treatments one to four times after the initial treatment.
Survival rates vary widely with this procedure. Studies have reported survival rates ranging from 35-88% for 1 year, 20-64% for 2 years, and 11-51% for 3 years. Median survival is less than 10 months. Several studies show no survival benefit of chemoembolization over embolization alone.
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