Chemoembolisation

What is a chemoembolisation?

Chemoembolisation is a combination of local delivery of chemotherapy into an artery followed by blocking of the artery from the inside.

In chemoembolisation, anti-cancer drugs are injected directly into the artery supplying a cancerous tumour. Embolisation particles are then placed into the blood vessels that feed the tumour, effectively trapping the chemotherapy in the tumour and stopping the artery supplying nutrients to the tumour.

Reasons why you may require chemoembolisation

Chemoembolisation is most beneficial to patients whose disease is predominately limited to the liver.

Cancers that may be treated by chemoembolisation are:

• hepatocellular carcinoma (HCC or primary liver cancer)
• metastasis (spread) to the liver from:
  • carcinoid tumours and other neuroendocrine tumours
  • other vascular primary tumours.

How does it work?

Chemoembolisation attacks the cancer in two ways. Firstly, by delivering a very high concentration of chemotherapy directly into the tumour, without exposing the entire body to the effects of the chemotherapy. Secondly, the procedure cuts off the blood supply to the tumour, trapping the chemotherapy drugs at the site and depriving the tumour of oxygen and nutrients it needs to grow.

What you may need to tell your doctor or nursing staff looking after you:

• if you have had a previous reaction to contrast
• if you have liver or kidney disease
• if you are pregnant
• if you have blood clotting problems
• if you are taking blood thinning medication (warfarin, aspirin, clopidogrel or anti-inflammatories).

How is it performed?

Chemoembolisation is performed by a specially trained interventional radiologist in the CardioVascular Unit at Mater Private Hospital Brisbane.

You may be given medication to help prevent nausea and pain before the procedure. This will be through an IV drip in your arm.

You will be positioned on the procedural table and connected to monitors that track your heart rate, blood pressure and pulse during the procedure.

Local anaesthetic is injected into your groin and a small nick is made in the skin at the site. A thin catheter is then inserted into the femoral artery and advanced into the liver. Contrast dye is then injected to visualise the arteries and tumour on X-ray. X-ray images will be taken to map the path of blood vessels feeding the tumour.

Once the catheter is positioned in the feeding arteries of the tumour, the chemotherapy and embolisation particles are delivered.

Additional X-rays will be taken to confirm that the entire tumour has been treated.

The catheter will then be removed and pressure will be applied to your groin to stop any bleeding. The opening in the skin is then covered with a dressing. No sutures are needed.

Expect to stay in bed for 4–6 hours. Most patients require an overnight stay in hospital. On some occasions it may be possible to perform the procedure as a day case without an overnight stay.

The chemoembolisation procedure usually takes up to 90 minutes but commonly may last longer depending on your vascular anatomy, tumour size and tumour number.

What will I experience during and after the procedure?

• Devices to monitor your heart rate and blood pressure will be attached to your body.
• You will feel a slight pin prick when the local anaesthetic is inserted into your groin. This feeling usually only lasts up to 15 seconds.
• You maybe given IV sedation which will make you feel relaxed and sleepy. You may or may not remain awake, depending on how deeply you are sedated.
• You may feel slight pressure when the sheath in inserted into the artery in your groin. This should not cause extreme discomfort and only last for a few seconds.
• As the contrast dye passes through your body you may feel a warm feeling. This is nothing to be concerned about.
• You may experience some side effects. These may include pain, nausea, vomiting and fever. These side effects are readily controllable with specific medication given before or after the procedure.
• You should leave hospital within 48 hrs depending upon the after effects (pain, nausea etc)
• You should be able to resume normal activities within a week of the procedure.
• Your physician may require you to have a CT scan before your discharge and subsequent scans throughout your treatment.

What are the risks?

The chance of any complication is low. Risks include:

• bruising
• haematoma or damage to the artery at insertion site
• damage to arteries
• damage to the liver
• infection
• reaction to chemotherapy (usually very mild as chemo is locally injected)
• serious complications from chemoembolisation occur in around 1 in 50 cases. Most major complications involve either infection or damage to the liver.

What are the Benefits?

• In about two-thirds of cases treated, chemoembolisation can stop liver tumours from growing or cause them to shrink, depending on the type of tumour.
• Chemoembolisation is often repeated to keep the tumour(s) under control.
• Other types of therapy (tumour ablation, chemotherapy) may be used in combination with chemoembolisation.
• When cancer is confined to the liver, most deaths that occur are due to liver failure caused by the growing tumour, not due to the spread of cancer throughout the body. Chemoembolisation can help prevent this growth of the tumour, prolonging life and minimising symptoms of tumour growth.

You will be required to sign a consent form to say that the procedure has been explained to you fully, including risks and benefits. If you need any clarification please ask your doctor for more information before you sign.

Mater Private CardioVascular Unit

Mater Private Hospital Brisbane
Level 6, 301 Vulture Street, South Brisbane,
Queensland 4101

Telephone: 07 3163 6700
Bookings: 07 3163 1146 or 07 3163 1147
Facsimilie: 07 3163 6720

www.mater.org.au

© 2010 Mater Misericordiae Ltd. ACN 096 708 922.

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