Transarterial Chemoembolization (TACE) is a minimally invasive intervention used to treat certain liver tumors when surgical removal is not feasible. It delivers chemotherapy directly to the tumor via its arterial blood supply and simultaneously blocks that supply, starving tumor cells of oxygen and nutrients. In India, TACE has gained popularity due to its effectiveness, relatively lower risk, and cost advantages compared to more extensive surgery or systemic therapies.
In India, with proper patient selection, the average TACE cost is estimated to be between USD 5,000 and USD 7,000 per session, although this depends significantly on the hospital, liver function, tumor extent, and whether it requires repeated sessions. In comparison, the same treatment can cost between USD 20,000 and USD 40,000 in the US or between USD 15,000 and USD 25,000 in Europe. Despite the lower price, Indian hospitals maintain global standards of safety, success, and patient care.
With support from trusted medical coordinators like HealZone, international patients receive transparent cost estimates, travel support, and post-procedure follow-up guidance.
What is TACE?
TACE (Transarterial Chemoembolization) is a targeted therapy often used in hepatocellular carcinoma (HCC) or metastatic liver lesions.
TACE combines two powerful actions:
- Localized chemotherapy is delivered directly to the liver tumor.
- Arterial embolization blocks the tumor’s blood supply.
This dual mechanism starves the tumor while maximizing local drug concentration and minimizing side effects.
Mechanism of Action of TACE
- A catheter is introduced (typically via the femoral artery) and guided into the hepatic artery branches supplying the tumor.
- A mixture of chemotherapy agents and embolic materials (like microspheres) is injected, delivering a high drug dose locally and then blocking the vessel.
- The dual action (chemo + ischemia) leads to tumor cell death while sparing much of normal liver tissue (which receives blood supply mainly from the portal vein).
By constraining blood flow, the tumor gets a “double hit,” cytotoxic exposure and starvation.
What are the Types / Variants of TACE?
TACE is of the following 4 types:
- Conventional TACE (cTACE): Chemotherapy (often doxorubicin, cisplatin) emulsified with lipiodol + embolic agents.
- Drug-Eluting Bead TACE (DEB-TACE): Uses microspheres that slowly release chemo over time.
- Super-selective / segmental TACE: Catheterization into smaller arterial branches for more focused treatment.
- Combination TACE / adjunct therapies: TACE + radiofrequency ablation (RFA) or TACE + systemic therapy.
Choice of variant affects cost, complexity, and outcome.
Who is a Candidate for TACE?
Not every patient with liver cancer is eligible for TACE. Determining candidacy requires a multidisciplinary assessment.
Typical Criteria
- Patients with intermediate-stage HCC (multinodular, unresectable, but preserved liver function).
- Tumor confined to the liver, without vascular invasion or extrahepatic spread.
- Adequate liver function (Child-Pugh A or selected B).
- No uncontrolled ascites, encephalopathy, or severe comorbidities.
- Good performance status.
When TACE May Be Precluded?
- Poor liver reserve (Child-Pugh C).
- Portal vein thrombosis (major) or vascular invasion.
- Extrahepatic metastases dominate prognosis.
- Severe coagulopathy or contraindications to angiography.
- Significant renal dysfunction or allergy to contrast.
TACE is often used as bridge therapy before liver transplantation or as palliative treatment.
What are the Benefits of TACE?
TACE offers several important advantages in suitable patients.
- Tumor control: Shrinkage, stabilization, slowing of progression.
- Symptom relief: Alleviation of pain, abdominal discomfort, and symptoms of mass effect.
- Preservation of liver: Less invasive than surgical resection, preserving liver tissue.
- Bridge to surgery or transplant: Helps downstage tumors, making them resectable or transplant-eligible.
- Repeatable: Can be repeated when needed, depending on liver tolerance.
- Lower systemic toxicity: Because chemo is localized, systemic side effects are reduced.
In many centers, TACE increases median survival for appropriate patients and improves quality of life.
What are the Risks, Side Effects & Complications of TACE?
While TACE is considered safer than surgical options, it carries possible risks that must be managed.
Common side effects / complications:
- Post-embolization syndrome, including fever, pain, nausea, vomiting, elevated liver enzymes
- Hepatic decompensation (especially in marginal livers)
- Liver abscess or infection
- Bile duct injury or ischemia
- Non-target embolization (damage to healthy tissue)
- Contrast-induced nephropathy
- Bleeding from the catheter site
- Rarely, liver failure
Proper patient selection and careful technique reduce these risks.
Pre-procedure Workup & Evaluation
Before TACE, thorough preparation ensures safety and planning.
- Blood tests: CBC, LFT (liver function), renal function, coagulation profile
- Tumor markers: AFP (alpha-fetoprotein)
- Imaging: Multiphasic CT or MRI of liver, vascular mapping
- Angiography planning: Evaluate arterial anatomy, collaterals
- Baseline performance and comorbidity evaluation
- Consent and counseling: Risks, expected benefits, possibility of repeat sessions
These steps allow the interventional radiologist to tailor the TACE plan.
Step-by-Step Procedure of TACE
Here is the typical workflow for TACE:
- Preparation & anesthesia: Local anesthesia plus mild sedation.
- Vascular access: Puncture the femoral artery (groin) and insert a sheath.
- Catheter navigation: Guide the catheter to the proper hepatic artery or branch supplying the tumor.
- Angiography: Contrast injection to map arteries and tumor blush.
- Chemo infusion: Administer chemotherapy mixed with Lipiodol or beads.
- Embolization: Deliver embolic particles to block arterial flow.
- Final angiogram: Confirm vessel occlusion and tumor perfusion drop.
- Sheath removal & closure: Apply pressure or closure device to the femoral site.
- Recovery & monitoring: Observation for complications, vital signs, and labs.
Procedure duration: ~1 to 2 hours, depending on complexity.
Hospital stay: typically 1-2 days, but sometimes up to 3 days.
