Surgery is the gold standard for treating hepatocellular carcinoma (HCC). But 70% to 90% of the patients are unsuitable for resection due to extensive intrahepatic tumor involvement, extrahepatic disease and poor liver reserve.

In these patients, conventional transarterial chemoembolization (TACE) is considered one of the standard treatment options for patients with HCC. TACE is the blockade of tumorous arterial flow through embolic material, which carries chemotherapeutic drugs.

In this method, the catheter/microcatheter is selectively placed in the hepatic artery via the common femoral artery to visualize the blood vessels supplying the tumor and identify the tumor-feeding arteries. This is followed by infusing a chemotherapeutic drug, such as doxorubicin, emulsified with lipiodol, a carrier of a chemotoxic drug. The viscosity of lipiodol creates a temporary vascular embolization effect. Lastly, particulate agents are injected.

The rationale behind using TACE for such patients are: Tumor-fed primarily from hepatic arteries; intro-arterial injection of anticancer drugs; higher intratumoral concentration; minimize systemic side effects; relatively inexpensive compared to other endovascular techniques.