Chemoembolization & Radioembolization

The liver is supplied by two vessel systems: the portal vein and the hepatic artery. Normal liver tissue receives most of its blood from the portal vein whereas liver tumors receive their blood mainly from the hepatic artery. Interventional radiology uses this difference: medicine or radioactive particles are delivered directly into the arterial branch feeding the tumor, giving the tumor concentrated treatment while healthy liver tissue is relatively spared.

These methods can be used for hepatocellular carcinoma (the primary cancer of the liver), tumors that have spread to the liver from other organs (metastases) and some bile duct tumors. The decision is made by the oncology, gastroenterology, surgery and radiology team together.

In transarterial chemoembolization a catheter entering at the groin or wrist is advanced to the liver artery feeding the tumor. A chemotherapy drug is delivered directly into the tumor and then the vessel is blocked with small particles. The tumor receives a high concentration of the drug while its blood and oxygen supply is cut off. Some methods use drug-loaded microspheres (DEB-TACE).

After the procedure fever, abdominal pain, nausea and fatigue (post-embolization syndrome) are common and usually last a few days. A short hospital stay is needed. The procedure can be repeated at intervals when necessary.

Radioembolization (SIRT) uses very small microspheres loaded with a radioactive substance called yttrium-90. The microspheres are delivered into the vessel feeding the tumor and lodge in the tumor, delivering a high dose of radiation to an area a few millimeters across. The radiation effect stays limited around the tumor.

Before the procedure a planning angiography and nuclear imaging are done to map the vessels and to measure whether any of the material would shunt to the lungs. This preparatory assessment is very important for safety. Treatment can be planned as a single lobe or as separate sessions for both lobes.

One of the studies in which the doctor is among the authors (2022) showed that the radiation dose absorbed by healthy tissue after radioembolization of one lobe helps to predict growth of the opposite lobe; another (2024) tried to predict metabolic response after Y-90 resin microsphere treatment in hepatocellular carcinoma using dose-volume histograms.

The procedure may not be suitable in cases of severely impaired liver function, some situations where the portal vein is completely blocked, severe kidney failure or contrast allergy. The patient's general condition and liver reserve are assessed in detail beforehand.

Risks include temporary deterioration of liver function, infection, injury to the bile ducts and stomach-duodenum, bleeding at the access site and rarely liver failure. In radioembolization there is also a risk that radiation reaches the lungs, which is why pre-treatment planning is done.

Liver tumor treatment is the work of a team rather than a single specialist. The oncologist, gastroenterologist/hepatologist, surgeon, nuclear medicine specialist and interventional radiologist assess the patient together. The aim of tumor treatment is to control the disease, preserve quality of life and maintain suitability for other treatments.

In follow-up after treatment, response is assessed with blood tests, tumor markers and MRI or CT; sessions are repeated if needed. Patients should contact us or the oncology team if fever, pain, jaundice or abdominal swelling develops after the procedure.

At the first consultation your complaints, medical history, medications (especially blood thinners and diabetes drugs), allergies and previous imaging and test results are reviewed together. The type and extent of the tumor, previous treatments, liver function and the oncology team's plan are reviewed in advance. Please bring previous reports, films and CDs, your current medication list and any blood test results.

If needed, additional imaging or tests are requested. Whether the treatment is suitable, how the procedure will be done, the possible risks and the alternatives are explained in detail; your questions are answered and the procedure is planned after your consent is obtained.

Preparation instructions are given according to the type of procedure and the patient's condition. In general this involves fasting for a set time before the procedure, having tests that show kidney function and bleeding-clotting values and adjusting some medications as advised by the doctor. Always tell us if you are allergic to contrast material or medicines.

Having a relative with you on the day of the procedure is helpful for returning home after discharge.

Consultations and procedures are carried out in person at Ankara City Hospital, Neuro-orthopedics Building, Department of Radiology, Interventional Radiology Unit; online consultation is not offered. Appointments can be made on DoktorTakvimi via the Book button or by phone at 0850 333 0388. See the Contact page for the address and directions.