In trans-arterial chemoembolization (TACE) for hepatocellular carcinoma, the rationale for combining chemotherapy with embolization is based on:

• A HCC is exclusively supplied by portal vein blood, allowing selective embolization
• B Gelfoam embolization permanently occludes hepatic artery branches, causing tumor necrosis
• C Lipiodol alone without chemotherapy is sufficient for HCC treatment
• D HCC is predominantly supplied by hepatic artery; embolization selectively deprives tumor while sparing portal-supplied hepatocytes, and high local drug concentrations increase cytotoxicity ✓

Explanation

The dual blood supply of the liver underlies TACE: normal hepatocytes receive ~75% blood from the portal vein and only ~25% from the hepatic artery, whereas HCC (a hypervascular tumor) derives ~90% of its supply from the hepatic artery. Selective intra-arterial chemoembolization therefore disproportionately affects tumor vasculature (ischemia + high local drug concentration) while relatively sparing portal-supplied background liver parenchyma. Lipiodol acts as a chemotherapy carrier, concentrating within HCC due to absent Kupffer cells. TACE is indicated for intermediate-stage (BCLC B) unresectable HCC.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.