Chemoembolization of hepatic malignancies

Chemoembolization has several theoretical advantages over intravenous or intraarterial infusion therapy for treatment of primary or metastatic liver tumors. This technique delivers highly concentrated drugs to the tumor, then arrests blood flow. This renders the tumor ischemic, while achieving a drug concentration in the tumor 10 to 25 times greater than can be achieved by infusion. The dwell time for the drug is markedly prolonged, with measurable drug levels present in tumor as long as a month after chemoembolization. Up to 85% of the administered drug is trapped in the liver, minimizing systemic toxicity. Worldwide experience has established chemoembolization as the treatment of choice for unresectable hepatoma. Metastatic lesions from ocular melanoma, neuroendocrine tumors, and sarcomas have been reported to respond well to chemoembolization. The technique also shows promise against colorectal metastases.