BlueCross BlueShield of Tennessee Medical Policy Manual

Transcatheter Hepatic Arterial Chemoembolization

DESCRIPTION

Transcatheter arterial chemoembolization (TACE) of the liver is a proposed alternative to conventional systemic or intra-arterial chemotherapy and to various nonsurgical ablative techniques, to treat nonresectable tumors. TACE is a minimally invasive procedure performed by interventional radiologists who inject highly concentrated doses of chemotherapeutic agents into the tumor tissues to restrict tumor blood supply. The embolic agent(s) causes ischemia and necrosis of the tumor, extending the retention of the chemotherapeutic agent and decreasing systemic toxicity. The liver is especially amenable to such an approach, given its distinct lobular anatomy, the existence of two independent blood supplies and the ability of healthy hepatic tissue to grow and thus compensate for tissue mass lost during chemoembolization.

The TACE procedure requires hospitalization for placement of a hepatic artery catheter and workup to establish eligibility for chemoembolization. Prior to the procedure, the patency of the portal vein must be demonstrated to ensure an adequate post-treatment hepatic blood supply. Typically, only one lobe of the liver is treated during a single session, with subsequent embolization procedures scheduled from 5 days to 6 weeks later. In addition, since the embolized vessel recanalizes, chemoembolization can be repeated as many times as necessary.

Note:  This policy does not apply to requests for venous occlusion of the portal vein.

POLICY

MEDICAL APPROPRIATENESS

IMPORTANT REMINDERS

ADDITIONAL INFORMATION 

Child-Pugh score is a scoring system used to assess prognosis in individuals with chronic liver disease and cirrhosis. The score considers total bilirubin, serum albumin, INR, degree of ascites and hepatic encephalopathy. 

SOURCES 

American Association of Liver Disease. (2018). AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology, 67 (1), 358-380.

BlueCross BlueShield Association. Evidence Positioning System. (7:2018). Transcatheter arterial chemoembolization to treat primary or metastatic liver malignancies (8.01.11). Retrieved January 17, 2019 from http://www.evidencepositioningsystem.com. (80 articles and/or guidelines reviewed)

BlueCross BlueShield of Tennessee network providers. April 2009.

BlueCross BlueShield of Tennessee network providers. July-August 2005.

BlueCross BlueShield of Tennessee network providers. June-August 2000.

Finn, R., Zhu, A., Farah, W., Almasri, J., Zaiem, F., & Prokop, L. (2018). Therapies for advanced stage hepatocellular carcinoma with macrovascular invasion or metastatic disease: a systematic review and meta-analysis. Hepatology, 67 (1), 422–435. (Level 1 evidence)

Heimbach, J., Kulik, L., Finn, R., Sirlin, C., Abecassis, M., Roberts, L., et al. (2018). AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology, 67 (1), 358-380. (Level 1 evidence)

Kulik, L., Heimbach, J., Zaiem, F., Almasri, J., Prokop, L., Wang, Z (2018). Therapies for patients with hepatocellular carcinoma awaiting liver transplantation: a systematic review and meta-analysis. Hepatology, 67 (1), 381=400. (Level 1 evidence)

Li, L., Tian, J., Liu, P., Wang, X., & Zhu, Z. (2016, June). Transarterial chemoembolization combination therapy vs monotherapy in unresectable hepatocellular carcinoma: a meta-analysis. Tumori Journal, 2016 (3), 301 - 310. Abstract retrieved February 9, 2017 from PubMed database.

National Comprehensive Cancer Network. (2018, December). NCCN clinical practice guidelines in oncology (NCCN Guidelines®). Hepatobiliary cancers. (V.1.2019). Retrieved January 17, 2019 the National Comprehensive Cancer Network.

National Comprehensive Cancer Network. (2018, March). NCCN clinical practice guidelines in oncology (NCCN Guidelines®). Uveal Melanoma. (V.1.2018). Retrieved January 17, 2019 the National Comprehensive Cancer Network.

National Comprehensive Cancer Network. (2019, January). NCCN clinical practice guidelines in oncology (NCCN Guidelines®). Neuroendocrine Tumors. (V.4.2018). Retrieved January 17, 2019 the National Comprehensive Cancer Network.

Zacharias, A. J., Jayakrishnan, T. T., Rajeev, R., Rilling, W. S., Thomas, J. P., George, B., et al. (2015). Comparative effectiveness of hepatic artery based therapies for unresectable colorectal liver metastases: a meta-analysis. PloS One, 10 (10), 1-10. (Level 1 evidence)

ORIGINAL EFFECTIVE DATE:  6/1/2000

MOST RECENT REVIEW DATE:  3/28/2019

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Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

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