TACE (transarterial chemoembolization) is a procedure in which a thin tube (catheter) is passed from an artery in the groin or wrist to the vessels feeding a liver tumour, where anticancer drugs are delivered directly and the vessels are then blocked. Guidelines around the world recommend it as a standard treatment for intermediate-stage liver cancer when surgery or ablation is not suitable, and it has been used for many years in Japan, Europe and the United States. In an analysis of more than 10,000 patients, 52.5% saw their tumours shrink and median overall survival was 19.4 months.
Drawing on the patient guide of the Cardiovascular and Interventional Radiological Society of Europe (CIRSE), a systematic review in the journal Hepatology, Japan's National Cancer Center information service and a UK NHS hospital leaflet, this article explains how TACE works, who it is for, the procedure, recovery time, side-effect care and outcomes.
Treatment status · TACE is an approved, standard treatment for liver cancer (hepatocellular carcinoma) included in Japanese, European and US guidelines. The Barcelona Clinic Liver Cancer (BCLC) system lists TACE as the main treatment for intermediate-stage (stage B) disease. This article is general information, not a treatment recommendation.
What is TACE?
The healthy liver gets most of its blood from the portal vein, while liver cancers are fed mainly by the hepatic artery. TACE uses this difference. Under X-ray guidance, an interventional radiologist advances a catheter into the branch of the hepatic artery that supplies the tumour and injects anticancer drugs followed by an embolic agent. The drug stays in the tumour longer, and the blocked vessels cut off its oxygen and nutrients.
According to CIRSE, much less drug reaches the rest of the body than with chemotherapy given through an arm vein. Whole-body side effects such as hair loss or low white blood cell counts are therefore less common, and TACE combines easily with other treatments.
| Method | What is delivered | Features |
|---|---|---|
| Conventional TACE (cTACE) | Anticancer drug mixed with Lipiodol (an oily contrast agent), then an embolic agent | The longest-established method; widely used in Japan |
| Drug-eluting bead TACE (DEB-TACE) | Small beads loaded with an anticancer drug | Beads block the vessel while releasing the drug slowly |
| TAE (transarterial embolization) | Embolic agent only | Blocks the vessel without an anticancer drug |
| Radioembolization (TARE, Y-90) | Microspheres containing a radioactive isotope | Treats with radiation rather than by blocking flow |
Based on the CIRSE patient guide and Japan's National Cancer Center information service.
Radioembolization is covered in Y-90 radioembolization for liver cancer, and catheter-based procedures in general in our IVR (interventional radiology) guide.
Who receives it?
Japan's National Cancer Center information service explains that embolization is considered when liver function is Child-Pugh A or B and the patient has one to three tumours larger than 3 cm, or four or more tumours of any size. Surgery must be difficult and the tumours unsuitable for ablation. Widespread disease may be treated in several sessions.
- Typical case: intermediate-stage liver cancer with several tumours in the liver but no major vessel invasion or distant spread
- Other goals: keeping tumours under control while waiting for a liver transplant, or shrinking them to meet transplant criteria (CIRSE)
- Careful assessment needed: poor liver function, portal vein blocked by tumour, or poor kidney function
Liver function, staging and blood tests come first. See tests before liver cancer procedures for details.
Preparation and procedure
Details vary by hospital, but the CIRSE guide and the Royal Devon NHS leaflet describe the following steps.
| Step | What happens |
|---|---|
| Tests | Liver and kidney function and clotting tests; contrast CT or MRI within 30 to 60 days before the procedure |
| Medication | Tell the team about medicines and allergies. Blood thinners such as warfarin or aspirin are stopped some days before, as instructed |
| Fasting | No food or drink for 6 to 8 hours (CIRSE); 4 hours at some hospitals |
| Sedation and access | Sedation plus anti-nausea and pain medication; local anaesthetic at the groin or wrist, then a catheter into the artery |
| Embolization | Contrast maps the vessels; drug and embolic agent are injected into the tumour branch. You hold your breath briefly several times |
| Duration | Usually 1 to 2 hours (Royal Devon NHS) |
| Afterwards | Bed rest for up to 12 hours to prevent bleeding; discharge usually within 24 to 48 hours |
CIRSE patient guide; Royal Devon NHS leaflet (2021). Japanese guidance mentions rest for several hours to half a day.
You can return to your usual diet the day after the procedure. Bruising at the groin may appear but usually settles on its own.
Recovery and post-embolisation syndrome
Many patients have abdominal pain, nausea and fever after TACE. This is called post-embolisation syndrome and feels like a cold or flu. It reflects the tumour's response, is usually controlled with medication and typically settles within a few days. For the next 1 to 2 weeks, a mild fever, tiredness and reduced appetite are common parts of recovery.
Rare complications include bleeding at the puncture site, liver abscess, acute worsening of liver function, and non-target embolization (material reaching vessels of other organs), which can rarely cause cholecystitis, pancreatitis or gastritis. A liver abscess is treated with antibiotics or drainage.
| When | Common symptoms | Care |
|---|---|---|
| Day of procedure and next few days | Abdominal pain, nausea, fever | Pain relief, anti-nausea medicine, fever reducers |
| 1 to 2 weeks | Mild fever, tiredness, low appetite | Rest and regular meals |
| Contact your team at once | Pale, cold leg; groin bleeding; marked breathlessness; fever of 38°C or higher that persists; frequent diarrhoea | Call your care team immediately |
Adapted from the recovery advice and warning signs in the CIRSE patient guide.
What are the outcomes?
Lencioni and colleagues pooled conventional TACE results from 101 studies published between 1980 and 2013, covering 10,108 patients, in Hepatology (2016). Survival was 70.3% at 1 year, 51.8% at 2 years, 40.4% at 3 years and 32.4% at 5 years.
| Measure | Result | Note |
|---|---|---|
| Objective response rate | 52.5% | Share of patients whose tumours shrank meaningfully |
| 1-year survival | 70.3% | Pooled from 101 studies |
| 3-year survival | 40.4% | Pooled from 101 studies |
| 5-year survival | 32.4% | Pooled from 101 studies |
| Median overall survival | 19.4 months | 95% CI 16.2–22.6 months |
| Procedure-related mortality | 0.6% | Most common cause: acute liver failure |
Lencioni R, et al. Hepatology 2016;64(1):106-16. Figures combine studies from many countries and periods.
The authors noted that these figures match earlier randomized trials and that no new safety concerns emerged. The CIRSE guide also states that around 70% of patients see improvement after TACE. As this analysis covers data up to 2013, newer equipment, drugs and combination approaches have continued to improve results. For example, adding radiofrequency ablation after TACE showed good results in the TORCH phase 3 trial, and adding immunotherapy did so in the EMERALD-3 phase 3 trial.
Follow-up scans and repeat sessions
Blood tests check liver and kidney function in the weeks after the procedure, and a CT or MRI 1 to 3 months later shows tumour size and blood flow (some UK hospitals scan at 6 weeks). If the tumour still has a blood supply, a second or third TACE is planned. When tumours are in both halves of the liver, treatment may be split into sessions from the start.
Japan's National Cancer Center guidance explains that if two TACE sessions are not effective enough, or new tumours appear, the team reviews whether to switch to another approach such as drug therapy. Because decisions follow clear criteria, patients can discuss each next step with their doctors after every scan.
Japan and other countries
| Region | Status | Basis |
|---|---|---|
| Japan | A core treatment in the liver cancer algorithm for multiple tumours unsuitable for surgery or ablation; performed via groin, elbow or wrist arteries | National Cancer Center information service |
| Europe | CIRSE publishes patient guides and practice standards; discharge usually within 24 to 48 hours | CIRSE patient guide |
| United Kingdom | Performed in NHS hospitals with an overnight stay; CT at 6 weeks to check response | Royal Devon NHS leaflet |
| International guidelines | Main treatment for intermediate-stage (BCLC B) liver cancer | BCLC 2022 update |
International patients are often not covered by the host country's public insurance, so confirm costs and scheduling directly with the hospital.
TACE is one of the most widely used interventional radiology procedures in liver cancer care, so most university hospitals abroad have experienced teams. For small tumours suitable for ablation, see also liver cancer RFA: procedure and recovery.
Questions for your doctor
- Is TACE suitable for the number and size of my tumours and my liver function?
- Will you use conventional TACE or drug-eluting bead TACE?
- Will access be through the groin or the wrist, and how long is the hospital stay?
- How many sessions are planned, and when and how will the response be checked?
- Can TACE be combined with ablation or drug therapy?
For preparing your consultation, see also five questions before an RFA consultation.
Frequently asked questions
Is TACE painful?
It is done under sedation and local anaesthetic, so pain during the procedure is usually limited. For a few days afterwards, post-embolisation syndrome may cause abdominal pain or fever, which medication usually controls and which settles within days.
How long is recovery after TACE?
Most people go home within 24 to 48 hours and eat normally from the next day. Mild fever and tiredness may last 1 to 2 weeks, after which most people return to daily life.
How many TACE sessions are needed?
There is no fixed number. If a CT or MRI 1 to 3 months later shows remaining blood flow to the tumour, TACE is repeated. Japanese guidance reviews the response after two sessions to decide whether to change approach.
How is TACE different from radiofrequency ablation?
Radiofrequency ablation inserts a needle directly into the tumour and destroys it with heat, usually for a small number of tumours around 3 cm or less. TACE works through the blood vessels and can treat several tumours spread across the liver at once. The two are sometimes combined.
This article summarises overseas official sources and research as general information and is not medical advice. Please discuss treatment choices with a doctor who has examined the patient.
Sources (checked October 24, 2026)
- CIRSE. Patient Information: Transarterial chemoembolisation (TACE). Cardiovascular and Interventional Radiological Society of Europe.
- Lencioni R, de Baere T, Soulen MC, Rilling WS, Geschwind JF. Lipiodol transarterial chemoembolization for hepatocellular carcinoma: A systematic review of efficacy and safety data. Hepatology. 2016;64(1):106-16.
- National Cancer Center Japan, Cancer Information Service. Liver cancer (hepatocellular carcinoma): treatment. (Japanese-language source)
- Royal Devon University Healthcare NHS Foundation Trust. Transarterial chemoembolisation (TACE) for liver tumours. Patient information leaflet.
- Reig M, Forner A, Rimola J, et al. BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update. Journal of Hepatology. 2022;76(3):681-693.