1. Initial Consultation & Evaluation
- Comprehensive assessment by a hepatobiliary surgeon and interventional radiologist.
- Review of medical history, liver function, and overall health status.
- Discussion of treatment options, including TACE and potential surgical intervention if feasible.
2. Medical Records Review & Pre-Treatment Assessment
- Detailed analysis of prior imaging, laboratory tests, and treatment history.
- Evaluation of liver function using Child-Pugh Score and ALBI score to assess treatment tolerance.
3. Laboratory Investigations
- Complete blood count (CBC)
- Liver function tests (LFTs)
- Renal function panel
- Coagulation profile
- Tumor markers (Alpha-Fetoprotein – AFP)
- Hepatitis B and C serology (if applicable)
4. Pre-Treatment Imaging
- Contrast-enhanced CT scan or MRI of the liver to assess tumor size, vascular invasion, and suitability for TACE.
- Angiographic assessment to map hepatic artery anatomy.
- Additional PET scan if metastatic disease is suspected.
5. Multidisciplinary Tumor Board Discussion
Case review by a team of hepatobiliary surgeons, interventional radiologists, and oncologists.
Decision on treatment strategy:
- TACE as primary treatment (if surgery is not feasible).
- TACE as neoadjuvant therapy (prior to surgery or liver transplantation).
6. Pre-TACE Preparation
- Patient education regarding the procedure, risks, and expected outcomes.
- Pre-procedure hydration and renal function optimization.
- Antibiotic prophylaxis if required.
- Temporary discontinuation of anticoagulants if applicable.
7. Transarterial Chemoembolization (TACE) Procedure
- Patient transferred to the interventional radiology suite.
- Local anesthesia with conscious sedation or general anesthesia if indicated.
- Catheter insertion via femoral artery, advanced into the hepatic artery.
- Selective embolization of tumor-feeding arteries using chemotherapy (individual selection of chemotherapy) mixed with embolic agents.
- Post-procedure angiography to confirm successful embolization.
8. Immediate Post-TACE Monitoring
- Patient observed in the post-procedure recovery unit for 4–6 hours.
- Pain management with analgesics and antiemetics for post-embolization syndrome.
- Monitoring of vital signs, liver enzymes, and kidney function.
9. Hospital Stay & Recovery
- Observation for 24–48 hours if needed, especially in patients with compromised liver function.
- Gradual resumption of diet and mobility.
- Post-TACE syndrome management (fever, nausea, right upper quadrant pain).
10. Follow-Up & Response Assessment
- First imaging follow-up (CT/MRI) in 4–6 weeks to assess tumor response.
- Repeat AFP measurement to monitor treatment effectiveness.
- Consider repeat TACE if incomplete tumor response.
11. Long-Term Monitoring & Next Steps
- Regular imaging every 3 months to assess for recurrence or progression.
- Evaluation for surgical resection or liver transplantation if tumor burden is reduced.
- Discussion of systemic therapy (e.g., tyrosine kinase inhibitors like sorafenib) if disease progresses.
