M.Debyanti1,Sudarmanta2,Y.Supriatna2
1Resident and 2Staff of Radiology Departement, Faculty of Medicine,
Universitas Gadjah Mada and Sardjito General Hospital
4th – 6th May 2017, Indonesian Society of Radiology
Annual Scientific Meeting XII Yogyakarta

• Most common
malignancies in
Asia
• Prevalence and
incidence >>>
HEPATOCELLUL
AR CARCINOMA
(HCC)
< 20% of patients
are suitable for
liver-resection
surgery and
transplantation
Have very poor
prognosis
TRANSARTERIAL
CHEMOEMBOLIZA
TION (TACE)
Gold-standard
palliative
treatment of
unresectable HCC
(BCLC-B)

A 81 y.o. man with unresectable HCC
TACE was performed with a combination of
Lipiodol and Doxorubicin, without any other
treatment
CT-scan imaging and liver function tests were
performed before and after the TACE

July, 2011
Multiple
noduls
Nodul: 6.7 x
5.7 x 5 cm
ALT: 53.4
AST: 263.8
Total Bil.:
0.57
Alb: 3.95
March,
2016
Nodul: 4.3 x
4.5 x 6.7
cm
June,
2016
Nodul:
4.6 x 4 x
5.6 cm
Nov,
2016
ALT: 32.7
AST:
86.5
Total bil.:
0.26
Alb: 3.74
Jan,
2017
Nodul: 4.6
x 4.59 x 4.4
cm
ALT: 10
AST: 39
Total bil.:
0.83
Alb: 3.96
1st TACE in
Okt 2011
2nd TACE in
April 2016
3rd TACE in
Nov 2016
4th TACE in
Jan 2017
AFP:
1636

July 2011
March 2016
January 2017
June 2016
CT scan evaluation

Indicate
for
large
or
multinodular
HCC
relatively preserved
liver function
absence of cancer-
related symptoms
no evidence of
vascular invasion
extrahepatic spread
and no tumor thrombus
in portal vein
FIG. PROCEDURE OF TACE

TACE  injection of an embolic agent into
the tumor-feeding arteries to block its
major nutrient source, and results in
ischemic necrosis of the targeted tumor,
with minimal adverse effect
The dosage depends on the size of tumor.
In this case, given doxorubicin 10mg as an
embolant and lipiodol ultra fluid 10 cc, mix
homogently and administrated via arterial
chateterization to tumor gradually
according to the blood pulse.
PROCEDURE OF TACE

Age factor,
size of
tumor and
liver function
test, surgery
can not be
applied to
this patient.
TACE was
needed as a
palliative
treatment
Tumor size
decrease
52 %, and
the liver
function was
improved
The patient
survive
almost 6
years
whereas in several RCTs,
the most common survival
rate post TACE (alone)
treatment was 1 year.