Combines targeted chemotherapy with embolization to starve liver tumors of their blood supply — the standard first-line treatment for intermediate-stage liver cancer.
Liver tumours, particularly hepatocellular carcinoma (HCC), derive almost all of their blood supply from the hepatic artery, while healthy liver tissue is supplied mainly by the portal vein. This difference is what makes TACE possible: by delivering treatment through the hepatic artery, it's possible to target the tumour's blood supply quite selectively while largely sparing the healthy liver around it.
TACE combines two actions in a single procedure. First, a chemotherapy drug is delivered directly into the artery feeding the tumour, either mixed with an oily contrast agent (conventional TACE, or cTACE) or loaded onto small embolic beads that release the drug slowly over time (drug-eluting bead TACE, or DEB-TACE). Second, the same artery is then blocked off with embolic particles, cutting off the tumour's blood supply. The combination starves the tumour of oxygen and nutrients while keeping the chemotherapy concentrated at the tumour site for longer than a systemic infusion ever could.
The standard, first-line treatment for multiple tumours confined to the liver with preserved liver function.
When surgical resection or ablation isn't feasible for a particular tumour location.
To control tumour growth in patients waiting for a liver transplant.
Increasingly combined with targeted or immunotherapy drugs for more advanced disease.
A needle puncture is made at the wrist or groin under local anaesthesia and sedation.
A catheter is guided into the hepatic artery, and an angiogram maps the vessels supplying the tumour.
Chemotherapy combined with an embolic agent is injected directly into the tumour's blood supply.
Most patients are observed overnight and go home the following day.
TACE is most often discussed in the context of the Barcelona Clinic Liver Cancer (BCLC) staging system, which guides treatment choice for hepatocellular carcinoma based on tumour burden, liver function, and overall health:
Intermediate-stage HCC (BCLC B) — TACE is the standard, first-line treatment for patients with multiple tumours confined to the liver, preserved liver function, and no cancer-related symptoms, who aren't candidates for liver transplant.
Early-stage HCC (BCLC 0/A) — TACE may also be used here when surgical resection or ablation isn't feasible for a particular patient or tumour location, even though ablation is generally preferred where it can be done.
As a bridge to transplant — TACE is sometimes used to control tumour growth in patients waiting for a liver transplant, to keep them within transplant eligibility criteria.
In combination with other treatments — for more advanced disease, TACE is increasingly combined with targeted or immunotherapy drugs, or used alongside ablation for larger tumours, under the guidance of a multidisciplinary liver cancer team.
TACE isn't suitable for every patient — widespread disease outside the liver, poor underlying liver function, or blockage of the main portal vein generally make TACE unsuitable or unsafe, and shift treatment toward systemic therapy instead.
Access: under local anaesthesia and light sedation, a needle puncture is made in the wrist (radial) or groin (femoral) artery.
Mapping: a catheter is guided under X-ray guidance into the hepatic artery, and an angiogram maps the blood vessels supplying the tumour.
Selective catheterisation: wherever possible, the catheter is advanced as far as possible into the specific small branch feeding the tumour — a more selective approach than treating the whole liver lobe, which spares more healthy liver tissue.
Chemoembolization: chemotherapy, combined with an embolic agent, is injected through the catheter directly into the tumour's blood supply, then the vessel is embolized to block flow.
Recovery: most patients are observed overnight and go home the following day.
The procedure typically takes one to two hours, and treatment is often planned across more than one session — either to treat multiple tumours in stages, or to retreat a tumour that hasn't fully responded, which is assessed with follow-up imaging.
Most patients experience some degree of post-embolization syndrome after TACE — a combination of right-sided abdominal pain, low-grade fever, nausea, and fatigue that typically develops within a day of the procedure and settles over the following days to about a week. This is a normal, expected inflammatory response to the tumour tissue being starved of its blood supply rather than a complication, and is managed with pain relief and anti-nausea medication during a short hospital stay.
Because TACE works by cutting off blood flow rather than necessarily shrinking the tumour outright, response is judged using imaging criteria that specifically look at the amount of viable, blood-supplied tumour tissue remaining — rather than overall tumour size alone, which can remain similar even after a successful treatment if the tumour has become non-viable. Follow-up CT or MRI, usually about a month after the procedure, is used to assess this and decide whether further TACE, a different treatment, or observation is the right next step.
Getting the most out of TACE depends on accurate staging up front — confirming the tumour burden, liver function, and vascular anatomy before treatment — and on selective, precise catheter technique during the procedure itself, since more selective delivery generally means a better tumour response with less impact on healthy liver tissue. Decisions about when to repeat TACE, when to switch to or combine it with a different treatment, and when a tumour has become refractory to further TACE are best made by a team spanning interventional radiology, hepatology, and oncology, working from the same imaging and liver-function picture rather than any one specialty deciding in isolation.
For intermediate-stage disease, TACE is a disease-control treatment aimed at shrinking or stabilising tumours and prolonging survival, rather than a guaranteed cure — though for some early-stage tumours where surgery or ablation isn't possible, it can achieve a complete response.
Standard intravenous chemotherapy circulates throughout the whole body. TACE delivers the drug directly into the tumour's own blood supply and then blocks that blood flow, achieving a much higher local drug concentration at the tumour with fewer of the whole-body side effects.
The procedure itself is done under sedation, so it isn't painful at the time. Afterward, most patients experience post-embolization syndrome — abdominal pain, low-grade fever, and fatigue — for a few days, which is expected and managed with medication during a short hospital stay.
This varies by patient — some tumours respond well to a single session, while others are treated in a planned series, or retreated based on how much viable tumour remains on follow-up imaging.
Yes — TACE is often used alongside ablation for larger tumours, as a bridge to liver transplant, or combined with newer targeted and immunotherapy drugs for more advanced disease, as part of an individualised, multidisciplinary treatment plan.
At Neuro & Vascular, TACE is performed by Dr. Suresh Giragani, Consultant Interventional Radiologist at Apollo Hospitals, Jubilee Hills, Hyderabad, as part of a multidisciplinary approach to liver cancer care alongside hepatology and oncology colleagues.
Book a consultation with Dr. Giragani, or send your scans and reports for a specialist second opinion.