TARE Procedure: A Complete Guide for Liver Cancer Treatment

What is TARE?

TARE Procedure, also known as transarterial radioembolization, is a minimally invasive therapy in which radioactive microspheres (tiny beads) are delivered through the hepatic artery directly into the liver tumor. The microspheres emit radiation internally and also damage tumor cells while trying to spare as much healthy liver tissue as possible.

The microspheres emit radiation internally, destroying tumor cells while the short penetration distance of the radiation minimizes damage to surrounding healthy liver tissue.

These procedures used to treat various liver conditions, including:

• Primary Liver Cancer: Liver conditions such as hepatocellular carcinoma (HCC) and cholangiocarcinoma.
• Metastatic Liver Cancer: For some selected cases of metastatic liver cancer from the primary cancer like colon, breast and neuroendocrine tumors.

What’s to expect during the procedure?

Prior to any surgical procedure, a healthcare professional follows a set of guidelines. It also ensures the patient's safety throughout the process.

Here’s what happens before the procedure, including:

Before the procedure

• Anesthesia: Patients will receive a sedation or local anesthesia, depending on the patient's condition or doctor's preference.
• Imaging: Blood vessels are generally mapped using X-ray imaging and a material to identify the tumor and its blood supply.
• Tests: Some patients might have a physical examination, clinical laboratory tests and specialised imaging, such as an angiography. 

During the procedure

• Catheter inserter: A radiologist generally makes a small puncture, usually in the part of the groin, and inserts a long, thin tube commonly known as a catheter.
• Guidance: The catheter is guided through the blood vessels under a on time X-ray imaging until it reaches the hepatic artery, the blood vessel supplying the liver tumor.
• Microsphere delivery: A dose of Yttrium-90, also known as a radioactive material in the form of tiny glass or resin beads, also known as microspheres, is delivered through the catheter.
• Targeting: These microspheres are designed to lodge in the blood vessels that might feed the tumor. It helps to deliver a high dose of radiation directly to the cancer cells, while preserving healthy liver tissues.

Risks/ side effects of TARE procedure

In general, most people will tolerate this procedure well. While after the embolisation process, some patients might experience a condition called post-embolisation syndrome. Some of these symptoms may include discomfort, nausea, vomiting and a mild fever, which might stay for three days.

Here are few complications of TARE procedure, include:

• An increased risk of blood clotting: The TARE procedure might carry an increased chance of developing blood clotting, especially in pediatric patients. While blood clots can be highly dangerous, potentially leading to issues like deep vein thrombosis or pulmonary embolism. While close monitoring and appropriate measures are highly essential to reduce the risk. 
• Infections: These are some of the most common symptoms of the TARE procedure. This includes localised infections at the treatment site or systemic infections that can affect the entire body. On time medical attention and preventive measures are often taken to minimise the risk. 
• Kidney damage: These are relatively uncommon, and these can often lead to kidney failure. These might result from the contrast agents used during the procedures or others. 
• Liver damage: These procedures are essentially designed to target liver tumors; there is a potential risk of collateral damage to healthy liver tissue. This unintended liver damage can affect the liver function and lead to further complications, including jaundice or liver failure, which requires additional treatment. 
• Hair loss: This is a possible side effect of these treatments of TARE. It can occur in only small cases. While studies suggest that hair loss can be reversible once the treatment is completed.
• Anemia: This condition is usually characterised by a deficiency of red blood cells that can develop due to this procedure. This might be due to the impact of radiation on the ability of bone marrow to produce red blood cells.

An need for repeating the procedure: In some cases, the initial TARE procedure may not achieve the desired treatment outcome and a second treatment might be necessary.