TARE Procedure in Hyderabad

What is TARE?

Transarterial radioembolization (TARE) or selective internal radiotherapy (SIRT) is a relatively new form of local therapy available for different types of liver cancer. In this procedure small particles ( microspheres) containing radioactive material ( called 90-yttrium) are injected into the liver blood vessel ( hepatic artery) through a small catheter inserted through the patient’s groin under local anaesthesia.

Indications for TARE ( In whom it is useful) ?

TARE procedure is done for patients of locally advanced liver cancer who are otherwise not suitable candidates for liver resection or liver transplantation. Following liver tumors can be treated by TARE

• Hepatocellular carcinoma (HCC) - stage B and stage C. Specific case scenarios - HCC with portal vein thrombosis, Large inoperable HCC, HCC with border line liver function, Multicentric HCC. In all these cases it can be done in isolation or as a bridge to transplant
• Intrahepatic cholangiocarcinoma (ICC)
• Neuroendocrine liver metastasis
• Colorectal liver metastasis

How does the procedure effect/work on the cancer?

TARE is a palliative, not a curative treatment. But the patient benefits by extending their lives and improving quality of life. In some cases, it helps in downsizing the tumour load and helps in bridging for liver transplantation. The internal radiation therapy (microspheres) is delivered to the tumour through a catheter placed in the hepatic artery. Once infused, the microsphere lodge in the blood vessels near the tumour where they give off small amounts of radiation to the tutor site for several days. The radiation travels very short distance, so its effects are limited mainly to the tumour.

How is the procedure performed?

Radioembolization requires two short visits to the hospital. The first procedure is 2-3 hrs and is aimed at decreasing the complications. This procedure entails “mapping” out the anatomy of the arteries to the liver by injecting contrast in the liver arteries through a catheter from the groin. Any arteries that are not feeding directly to the liver are blocked with tiny coils to prevent the radioactive beads from floating to areas outside the liver. During the first procedure a “test dose” of radiation is directly infused into the liver artery that does not injure the tumor or the liver, but it assures the radiation does flow into the tumor and remains there. If the “test dose” of radioactive beads flow through the tumor and into the body, this test will demonstrate it. Approximately one week after the first “mapping” procedure and test radiation dose, the treatment dose of radiation is given. Neither requires a long recovery or bed rest, at home or in the hospital.

TARE- benefits and risks?

Benefits

• For patients with inoperable tumors, radioembolization can extend lives from months to years and improve quality of life. In some cases, it may allow for more curative options such as surgery or liver transplantation.
• Radioembolization produces fewer side effects compared to standard radiation therapy.
• No surgical incision is needed—only a small nick in the skin that does not have to be stitched.
• A higher dose of radiation to the tumor is given during radioembolization than with standard external beam therapy.

Risks

• Any procedure where the skin is penetrated carries a risk of infection. The chance of infection requiring antibiotic treatment appears to be less than one in 1,000.
• Any procedure that involves placement of a catheter inside a blood vessel carries certain risks. These risks include damage to the blood vessel, bruising or bleeding at the puncture site, and infection. However precaution is taken to mitigate these risks.
• There is a risk that the microspheres may lodge in the wrong place, putting the patient at risk for an ulcer in the stomach or duodenum. This happens in approximately two percent of patients.
• There is a risk of infection after radioembolization, even if an antibiotic has been given.

TARE - Limitations

Radioembolization is not indicated for every liver cancer patient. It is not useful if the tumor has spread beyond the confines of the of the liver into the rest of the body. Radioembolization is not recommended in cases of severe liver or kidney dysfunction, abnormal blood clotting or a blockage of the bile ducts.