Three approaches, different mechanisms
TACE delivers chemotherapy and embolic material into arteries feeding a tumor. Radioembolization delivers radioactive microspheres, often using yttrium-90. HAIC infuses chemotherapy through the hepatic arterial supply without the same embolization mechanism. They are not interchangeable names for one procedure.
| Method | Main action | Planning question |
|---|---|---|
| TACE | Local chemotherapy plus embolization | Can the liver tolerate the treated territory? |
| Radioembolization | Microspheres deliver radiation | Where will activity go, including unwanted shunting? |
| HAIC | Chemotherapy delivered through hepatic arteries | How is repeated delivery coordinated with systemic therapy? |
The liver outside the tumor matters
Tumor distribution, portal-vein involvement, bile-duct anatomy, bilirubin, albumin, ascites and performance status affect selection. A technically accessible artery does not mean the liver can tolerate treatment. Extrahepatic disease and the best systemic options must also be considered.
Treat the tumor while preserving the remaining liver
The same tumor burden can mean very different risk in a well-functioning liver and in decompensated cirrhosis. Ascites, bilirubin trends and the amount of functioning liver outside the target influence the decision. Technical access is not the same as clinical suitability. The plan should leave room for the next treatment if needed.
Source [1]
Global treatment frontiers
As immune-based systemic treatments improve, the key question is what an arterial procedure adds to a contemporary regimen. Earlier Chinese randomized work showed the value of FOLFOX HAIC plus sorafenib over sorafenib alone in selected HCC with portal-vein invasion, addressing a difficult population rather than all liver cancers.
Current development focuses on integrating liver-directed therapy with modern immune and anti-angiogenic regimens. The practical question is which patients need additional liver control, and how to preserve liver function while coordinating systemic treatment. The combination is selected for the clinical setting rather than added routinely.
Mapping and sequencing
Angiography maps the arterial supply. Radioembolization also requires specific assessment of distribution and unwanted radiation exposure, including shunting. HAIC may require repeated access or an implanted delivery system. The plan should specify reassessment timing and when to stop or switch rather than repeat an ineffective local therapy.
Agree on a stopping or switching rule
Repeat arterial treatment only makes sense if benefit and liver tolerance remain favorable. Ask which scan and laboratory changes will lead to another session, a different local method or systemic therapy. Worsening ascites, jaundice or general function should trigger reassessment, not automatic repetition of the previous procedure.
Source [1]
Preventing loss of liver reserve
Pain, fever, nausea, infection, marrow suppression and liver decompensation are potential problems, with different profiles by method. Non-target embolization or radiation can injure other organs. Ask how liver function will be reassessed and whether the approach preserves future systemic treatment, surgery or transplantation options.
What to bring for a second opinion
- Recent multiphase liver imaging and a record of disease outside the liver.
- Liver-function trends, ascites history, portal-vein findings and prior procedures.
- The exact embolic, isotope or chemotherapy used and previous response.
- A current systemic-treatment plan and the reason for adding a regional procedure.
Estimated total treatment cost
These estimates cover the arterial treatment and associated medical care. TACE and yttrium-90 ranges cover one treatment; HAIC covers a series of infusions, with costs accumulating according to the actual number of treatments.
| Treatment | Estimated total treatment cost |
|---|---|
| TACE: one treatment | US$12,000–25,000 |
| Yttrium-90 resin microspheres: planning and one administration | US$68,000–88,000 |
| FOLFOX hepatic arterial infusion chemotherapy (HAIC) | US$32,000–79,000 |
What’s included
The total includes specialist assessment, necessary laboratory tests and imaging, catheter-based procedures, anesthesia or sedation where needed, the relevant medicines or microspheres, catheters and routine consumables, necessary hospitalization and nursing, supportive medicines, and early follow-up. The yttrium-90 estimate includes mapping, nuclear medicine assessment and dosimetry before treatment. Travel and accommodation are not included.
Your treatment plan
The treated area, materials, number of sessions and care needs affect the total. Repeat or staged radioembolization and separately arranged targeted therapy, immunotherapy or other anticancer treatments add to the cost. HAIC does not have one fixed course for every patient. Contact us for a personalized estimate.
Evidence & sources
Prepared by Chirona’s content team from the sources below. This guide supports a discussion with your treating team; it does not determine an individual treatment plan.