# Transarterial Chemoembolisation > TACE for hepatocellular carcinoma in NEET-PG Radiology: BCLC B indication, procedure steps, post-embolisation syndrome, contraindications and mRECIST response. - Canonical URL: https://prepelephant.com/topics/neet-pg/radiology/tace-transarterial - Exam / course: NEET-PG · Subject: Radiology - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-02 - Last updated: 2026-10-02 - How to cite: "Transarterial Chemoembolisation", PrepElephant, https://prepelephant.com/topics/neet-pg/radiology/tace-transarterial ## Direct answer Transarterial chemoembolisation (TACE) treats unresectable hepatocellular carcinoma by exploiting the tumour's almost exclusive dependence on hepatic arterial blood: a catheter is threaded from the femoral or radial artery into the tumour-feeding branch, a chemotherapy emulsion — commonly doxorubicin or cisplatin mixed with Lipiodol — is delivered, and the feeder is embolised so the drug is trapped while the supply is cut. It is the standard for intermediate-stage (BCLC B) disease in a Child-Pugh A or B liver, it is palliative rather than curative, and response is assessed by mRECIST, which measures viable enhancing tissue rather than total lesion size. Contraindications centre on decompensation — Child-Pugh C, jaundice, clinical encephalopathy — and on complete portal vein thrombosis in most protocols. ## What you must remember - **Where TACE sits in the BCLC algorithm:** very early/early (0-A) disease is for ablation, resection or transplant; intermediate (B) multinodular disease is for TACE; advanced (C) with vascular invasion or metastases is for systemic therapy; terminal (D) is supportive. TACE is for B. - **Procedure skeleton:** femoral or radial access, celiac and superior mesenteric angiography, microcatheter superselection of the segmental tumour feeder, chemotherapy-Lipiodol emulsion, then particles (PVA or gelatin sponge) until stasis. - **Two variants:** conventional TACE with Lipiodol emulsion, and DEB-TACE with drug-eluting beads releasing doxorubicin slowly — the latter gives more predictable pharmacokinetics, with broadly comparable outcomes. - **Post-embolisation syndrome:** fever, right upper quadrant pain, nausea and transient transaminase rise for a few days — expected and managed expectantly; a source of infection must still be excluded when fever persists. - **Contraindications:** Child-Pugh C or decompensation, bilirubin generally above about 2-3 mg/dL, complete portal vein thrombosis, extensive bilobar disease with poor liver reserve, and poor performance status. - **Response assessment:** mRECIST — viable tumour is enhancing tissue in the arterial phase; complete response means no enhancing focus, and assessment is with contrast CT or MRI at 4-8 weeks, then surveillance. - **Curative set for comparison:** resection for single tumours with preserved liver function, thermal ablation for lesions up to about 3 cm, and transplantation within the Milan criteria — one lesion up to 5 cm or up to three lesions each up to 3 cm, without vascular invasion or spread. ## One session, start to follow-up A 62-year-old with hepatitis B cirrhosis, Child-Pugh A, has two tumours of 3 cm and 2.5 cm in the right lobe and a patent portal vein. He is BCLC B and unsuitable for resection because of multinodularity. After right radial access, a microcatheter is parked in the segment VII feeder, a doxorubicin-Lipiodol emulsion is injected until the tumour blush saturates, and particles are delivered to stasis. He develops fever and pain that evening — post-embolisation syndrome — and settles with analgesia over 48 hours. Contrast CT at six weeks shows both lesions densely opacified with Lipiodol and no arterial enhancement: complete response by mRECIST. Surveillance continues, and a new enhancing nodule at one year triggers a further session or ablation, because TACE controls rather than cures. The scenario the exam tests against is the same patient arriving with bilirubin of 4 mg/dL and ascites: TACE now risks liver failure, and the correct answer moves to systemic or best supportive therapy — the procedure is judged by what it does to the remaining liver, not to the tumour. ## Where students slip The recurring slip is treating TACE as curative or as first-line for everything hepatic. It is palliative, repeated on demand, and outranked by ablation and surgery in early disease. The second is the portal vein physiology: arterial embolisation is survivable only if the portal vein is patent — hence portal vein thrombosis as the classical contraindication. Third is response assessment: candidates quote lesion shrinkage, but Lipiodol retention and necrosis keep lesions the same size while they are dead — which is precisely why mRECIST measures enhancement. In the Indian context, HCC arises mostly on hepatitis B and increasingly on non-alcoholic fatty liver disease cirrhosis, living-donor transplantation is the transplant reality, and TACE serves as the bridge to transplantation in listed patients — a viva answer that shows systems thinking rather than a procedure list. ## Frequently asked questions ### Which stage of hepatocellular carcinoma is treated with TACE? Intermediate-stage BCLC B disease — multifocal tumours without vascular invasion, metastases or decompensation — in a Child-Pugh A or B liver, as palliative therapy. ### How does TACE exploit hepatic blood supply? HCC is almost exclusively artery-supplied while the normal liver receives most inflow from the portal vein, so selective arterial chemotherapy and embolisation starve the tumour yet spare the parenchyma. ### What is post-embolisation syndrome? Self-limiting fever, abdominal pain, nausea and transaminase elevation for a few days after TACE, managed supportively while persistent fever prompts a search for infection or abscess. ### Which liver-related findings contraindicate TACE? Decompensated Child-Pugh C disease, significantly raised bilirubin, encephalopathy or refractory ascites, and complete portal vein thrombosis in most protocols. ### How is response to TACE assessed? By mRECIST on contrast CT or MRI, scoring only viable arterial-enhancing tissue, with complete response defined as disappearance of all enhancing foci regardless of residual lesion size.