Can TARE Treat Liver Cancer That Cannot Be Removed by Surgery?
When someone is diagnosed with liver cancer, surgery may seem like the most direct way to remove the tumour. However, surgery is not suitable for every patient. Sometimes, the tumour is too large, several tumours are present, or the remaining healthy liver may not be able to work properly after an operation.
Does that mean there are no treatment options left?
Not necessarily. TARE treatment is one option doctors may consider for selected patients whose liver tumours cannot be removed through surgery. It delivers radiation directly to the tumour through the blood vessels supplying it. The aim may be to control tumour growth, reduce the tumour size in suitable cases, or help manage the disease as part of a wider treatment plan.
Also known as Y-90 radioembolization, this procedure is a minimally invasive approach performed by trained specialists. However, it is not suitable for everyone, and the expected benefits depend on the type of cancer, liver function, tumour location and the patient’s overall health.
In this guide, Dr. Akash Bansal, Senior Consultant Interventional Radiology, explains how TARE works, who may benefit from it, what the procedure involves, and how it compares with other liver cancer treatment options.
Why Can Some Liver Cancers Not Be Removed by Surgery?
Surgery can be an effective treatment for certain liver tumours. During an operation, the surgeon removes the tumour along with a portion of the liver when necessary. For this to be possible, the tumour must be in a suitable location, and enough healthy liver tissue must remain to support normal body functions.
However, there are situations where surgery may not be recommended.
The tumour is too large or difficult to reach. A tumour may involve important blood vessels or lie in a location that makes safe removal difficult.
Several tumours are present. Multiple tumours spread across different parts of the liver may make surgery less suitable.
The liver is not healthy enough. Conditions such as cirrhosis can affect liver function. Removing part of the liver may create additional risks if the remaining tissue cannot function adequately.
Cancer has spread from another organ. Some patients develop liver tumours after cancer spreads from the colon, rectum or another part of the body. Their treatment depends on where the cancer started and whether it has spread elsewhere.
The patient’s general health limits surgery. Other medical conditions may increase the risks associated with a major operation.
When surgery is not possible, doctors assess other treatment options. These may include TARE treatment, transarterial chemoembolization (TACE), ablation, medicines that treat cancer throughout the body, or a combination of approaches.
The goal is to identify a treatment plan that fits the patient’s condition rather than assuming that every inoperable tumour should receive the same procedure.
What Is TARE Treatment for Liver Cancer?
TARE stands for Transarterial Radioembolization. It is also called radioembolization or selective internal radiation therapy (SIRT). The procedure commonly uses tiny radioactive particles containing yttrium-90, also known as Y-90.
Unlike surgery, which removes a tumour, TARE delivers radiation to targeted areas of the liver through its blood vessels. This radiation damages tumour cells and can help control the growth of selected liver tumours.
TARE treatment for liver cancer may be considered for certain patients with primary liver cancer, including hepatocellular carcinoma (HCC), and for selected patients with cancer that has spread to the liver.
The treatment is performed by guiding a thin tube, called a catheter, through a blood vessel towards the arteries supplying the tumour. Tiny particles carrying radiation are then delivered through the catheter.
Because the particles are directed towards the tumour’s blood supply, the radiation can be concentrated in the targeted area. Careful planning is needed to limit exposure to healthy liver tissue and other organs.
It is important to understand that TARE is not a guaranteed cure. Depending on the patient’s condition, the purpose may be to control the tumour, slow disease progression, support other treatments, or help make another treatment possible in selected cases.
How Does Y-90 Radioembolization Work?
Y-90 radioembolization works by delivering small radioactive particles through the blood vessels that supply a liver tumour.
The process usually involves several stages.
- Initial assessment
The specialist reviews the patient’s medical history, previous treatments, scans and blood test results. This helps determine whether radioembolization is a suitable option.
- Mapping and treatment planning
Before treatment, doctors map the blood vessels supplying the liver tumour. Imaging and a planning procedure help assess how the particles are likely to travel and whether radiation could reach unintended areas.
This stage is essential because the treatment must be carefully planned for each patient.
- Delivering the treatment
During the TARE procedure, the specialist inserts a catheter through a small puncture, usually in an artery in the wrist or groin. Using X-ray guidance, the catheter is moved towards the arteries supplying the tumour.
The Y-90 particles are then delivered through the catheter. The radiation acts over a short distance within the targeted area.
- Follow-up and monitoring
After treatment, the medical team monitors the patient’s recovery and arranges follow-up appointments and scans. Imaging helps assess how the tumour has responded and whether further treatment is needed.
The exact procedure, preparation and follow-up schedule may vary according to the treatment plan and the patient’s health.
Can TARE Treat Liver Cancer That Cannot Be Removed by Surgery?
Yes, TARE may be an option for selected patients with inoperable liver cancer. However, whether it is appropriate depends on several medical factors.
For example, a patient with liver cancer that is mainly confined to the liver may be assessed for radioembolization if surgery is not suitable. In some cases, the treatment may help control the tumour locally. In carefully selected situations, it may also reduce the extent of disease enough for doctors to reconsider other treatment options.
TARE for hepatocellular carcinoma (HCC) is one established use of this treatment. It may also be considered for selected patients with liver metastases, including some cases of colorectal cancer that has spread to the liver.
However, not every patient with advanced liver cancer will benefit. Doctors must consider how much of the liver is affected, whether cancer has spread outside the liver, how well the liver is functioning, and the patient’s overall condition.
The term “inoperable” does not automatically mean that TARE is the best alternative. It means the treatment team needs to evaluate other suitable options.
For some patients, systemic treatment such as chemotherapy, targeted therapy or immunotherapy may be more appropriate. Others may benefit from a combination of treatments.
The decision should be made by a multidisciplinary team that may include an interventional radiologist, medical oncologist, liver specialist, surgeon and other relevant experts.
Who Is Eligible for TARE Treatment?
There is no single rule that determines eligibility for every patient. The specialist assesses the cancer and the patient’s ability to tolerate the procedure.
Factors that may support consideration of TARE include:
- Liver cancer that cannot be removed safely through surgery.
- A tumour location and blood supply that allow treatment to be planned.
- Sufficient remaining liver function.
- An overall health condition that allows the patient to undergo the procedure.
- A treatment goal that can reasonably be supported by radioembolization.
Other factors may make the procedure unsuitable or require extra caution. These include severely reduced liver function, extensive tumour involvement, certain patterns of blood vessel involvement, or a risk that radioactive particles could reach the stomach or other unintended areas.
Patients with cancer that has spread widely outside the liver may also need treatment that addresses disease throughout the body, rather than liver-directed treatment alone.
The final decision should be based on individual assessment, not on the diagnosis alone.
What Are the Benefits and Risks of TARE Treatment?
One reason doctors consider TARE is that it treats a selected area of the liver without requiring a major operation.
Potential benefits include:
- A minimally invasive approach: Treatment is delivered through a blood vessel using a catheter.
- Targeted radiation: Radioactive particles are directed towards the blood supply of the tumour.
- Local tumour control: In suitable patients, treatment may slow tumour growth or reduce the tumour’s size.
- An option when surgery is not possible: It can form part of the treatment plan for selected inoperable liver tumours.
- Possible support for further treatment: In carefully selected cases, tumour response may allow doctors to reconsider surgery or other treatment options.
The benefits differ from person to person. TARE may control a tumour without removing it, and it may not prevent cancer from growing elsewhere.
As with other procedures, there are risks. Some patients experience tiredness, nausea, reduced appetite, abdominal discomfort or fever after treatment. Less common but serious complications can include damage to healthy liver tissue, infection, bleeding, injury to blood vessels, or radiation-related injury to the stomach or intestines if particles reach unintended areas.
The risk depends on liver function, tumour size and location, previous treatments, and the treatment plan. However the overall risks are minimal compared to open surgery or even systemic chemotherapy.
TARE vs TACE, Ablation and Other Liver Cancer Treatments
Patients and families often search for TARE vs TACE for liver cancer because both procedures deliver treatment through the liver’s blood vessels. Although they use similar catheter techniques, they work differently.
TARE vs TACE: TARE delivers radioactive particles to the tumour. TACE, or transarterial chemoembolization, delivers chemotherapy into the tumour’s blood supply and restricts blood flow. The choice depends on the type and extent of cancer, liver function and the patient’s overall treatment plan.
TARE vs liver tumor ablation: Ablation uses heat or another energy source to destroy a tumour directly. It may be suitable for selected tumours based on their size, number and location. TARE may be considered for different tumour patterns, depending on the patient’s condition.
TARE vs surgery for liver cancer: Surgery physically removes the tumour and some surrounding liver tissue. TARE delivers radiation through the blood vessels and does not remove the tumour in the same way. Surgery may remain preferable when the cancer can be removed safely.
TARE vs chemotherapy for liver cancer: Chemotherapy uses medicines to treat cancer. Depending on the cancer type, these medicines may affect cancer cells throughout the body. TARE is a liver-directed treatment and may be combined with other therapies when appropriate.
TARE vs immunotherapy for liver cancer: Immunotherapy helps the body’s immune system recognise and attack cancer cells. It works differently from radioembolization and may be appropriate for certain patients depending on the cancer type and stage.
These treatments are not always direct substitutes for one another. Comparing them requires consideration of the patient’s diagnosis, treatment goals, liver function and the possibility of combining different approaches.
TARE for Liver Metastases: Is It an Option?
Liver metastases develop when cancer spreads to the liver from another part of the body. Their treatment depends on the original cancer, the extent of spread and the available treatment options.
Radioembolization for liver metastases may be considered in selected patients, including some with colorectal liver metastases. It may be used when the liver is an important site of disease and local treatment is considered appropriate.
However, treating the liver alone may not be enough if cancer is also active in other organs. The medical team must consider the full picture before recommending liver-directed treatment.
For this reason, TARE for colorectal liver metastases and other metastatic cancers should be assessed as part of an overall cancer care plan.
Preparation, Procedure and Recovery After TARE
Preparation for TARE treatment usually includes a review of medical history, blood tests and scans. These help assess liver function, kidney function where relevant, blood clotting and the location of the tumour.
The patient may also need a mapping procedure to check the liver’s blood vessels and plan the treatment. The medical team will explain fasting instructions, medication changes and any precautions required before the procedure.
The TARE procedure is usually performed in a specialised setting with imaging guidance. After treatment, the patient is monitored before being discharged or admitted for further observation, depending on their condition and the centre’s protocol.
Recovery after TARE treatment varies. Some patients feel tired or experience nausea, reduced appetite or abdominal discomfort for a period after treatment. The care team will provide instructions on medicines, activity and follow-up.
Follow-up scans are important because the response is not always immediate. Doctors use imaging and clinical assessment to determine how well the tumour has responded and whether additional treatment is needed.
Conclusion: Is TARE Worth Discussing When Surgery Is Not Possible?
When liver cancer cannot be removed by surgery, it is still important to understand the available treatment options. TARE treatment may provide a liver-directed option for selected patients by delivering radiation through the blood vessels supplying the tumour.
Whether it is appropriate depends on the cancer type, tumour location, liver function, overall health and whether the disease has spread beyond the liver. Other options, including TACE, ablation, surgery in selected cases, chemotherapy and immunotherapy, may also be considered.
A detailed assessment can help patients understand the possible benefits, risks and realistic goals of treatment.
Dr. Akash Bansal, Senior Consultant Interventional Radiology, can help patients understand image-guided treatment options and the role they may have in an individual care plan. Discuss your reports and previous treatment history with a qualified specialist to determine which options may be suitable.
Medical disclaimer: This article is for general educational purposes only. It does not replace a medical consultation, diagnosis or individualised treatment advice.
Frequently Asked Questions About TARE Treatment
- What is TARE treatment?
TARE, or transarterial radioembolization, is a minimally invasive treatment that delivers tiny radioactive particles through the blood vessels supplying a liver tumour. It commonly uses yttrium-90 (Y-90).
- How does TARE treatment work?
A specialist guides a thin catheter into the arteries supplying the tumour and delivers Y-90 particles. The particles release radiation within the targeted area, helping damage tumour cells.
- How does Y-90 radioembolization work?
Y-90 radioembolization uses radioactive particles that travel through selected liver arteries. The treatment is planned to deliver radiation to the tumour while limiting exposure to surrounding healthy tissue.
- Who is eligible for TARE treatment?
Eligibility depends on the type and extent of cancer, liver function, general health and the blood supply to the tumour. A specialist must assess each patient individually.
- What are the benefits and risks of TARE treatment?
Potential benefits include targeted treatment and local tumour control without major surgery. Risks may include fatigue, nausea, abdominal discomfort, infection, bleeding or liver injury. The individual risk varies.
- What are the side effects of Y-90 radioembolization?
Possible side effects include tiredness, nausea, reduced appetite, fever and abdominal discomfort. Serious complications are less common but can include liver damage or injury to nearby organs.
- What is recovery like after TARE treatment?
Recovery varies according to the patient’s health and the extent of treatment. The medical team provides personalised instructions and arranges follow-up to monitor recovery and tumour response.
- How effective is Y-90 radioembolization?
Its effectiveness depends on the cancer type, tumour size and location, liver function and treatment goals. It may control selected liver tumours, but results cannot be guaranteed for every patient.
- Can TARE treat advanced or inoperable liver tumours?
TARE may be considered for selected patients with advanced or inoperable liver tumours. The suitability of treatment depends on liver function, the extent of cancer and whether disease is present elsewhere in the body.
- What tests are required before TARE treatment?
Assessment commonly includes blood tests, liver imaging such as CT or MRI, and a mapping procedure to evaluate blood vessels and plan treatment. Additional tests may be needed depending on the patient’s condition.
- How long does TARE treatment take?
The total process involves assessment, treatment planning, the procedure and follow-up. The time required for the procedure and any hospital observation varies by patient and treatment centre.
- What questions should I ask before TARE treatment?
Ask about the expected goal of treatment, potential benefits and risks, alternatives, preparation, recovery, follow-up scans and whether TARE may be combined with other cancer treatments.