Brazil’s public health system recorded 13,599 hospitalizations for a liver cancer procedure called chemoembolization between 2015 and 2025, but access to the treatment is heavily concentrated in a handful of states, leaving patients in the country’s vast northern region with almost nowhere to go locally. The figures come from the SUS Hospital Information System and were analyzed by CNN Brasil.
What the procedure does
Chemoembolization is an interventional radiology technique that uses real-time imaging to guide a catheter through the arteries to the blood vessels feeding a liver tumor. Once in position, doctors deliver chemotherapy drugs alongside an embolizing agent designed to cut off the blood supply to the lesion.
Ramon Andrade de Mello, vice president of the Brazilian Society of Cancerology, said the technique allows treatment to be concentrated directly on the tumor region and can also be used for patients who are not candidates for a liver transplant. He said the procedure is less invasive than surgery, with a shorter recovery time and the potential for a better quality of life.
The treatment may be indicated for certain patients with primary liver cancer or lesions that have spread to the organ, and can help control disease while a patient awaits a transplant. Under Ministry of Health guidelines, the SUS classifies it as palliative cytoreduction for inoperable hepatic cancer and allows up to three procedures per patient. The decision on whether to proceed must be made by a multidisciplinary team.
Five states handle nearly three-quarters of all cases
São Paulo led the country with 5,274 hospitalizations over the decade, equal to 38.8 percent of the national total. Rio Grande do Sul followed with 2,025 cases (14.9 percent), then Minas Gerais with 1,079 (7.9 percent), Pernambuco with 912 (6.7 percent), and Paraná with 776 (5.7 percent). Together, the five states accounted for 10,066 of the 13,599 hospitalizations recorded nationwide.
Lucas Moretti Monsignore, president of SOBRICE, the Brazilian Society of Interventional Radiology and Endovascular Surgery, said the concentration clearly reflects the current distribution of interventional radiology specialists in Brazil and the clustering of major hospital centers, oncology services, transplant teams, and high-complexity infrastructure. He said Brazil has just over 500 interventional radiologists, though not all work exclusively in the field and only a smaller fraction work regularly within the SUS. He added that almost half of those specialists are concentrated in São Paulo, while some states have few or no accredited professionals working in a structured way, noting that newly qualified doctors tend to settle where they find better working conditions, adequate equipment, and organized support services.
The North recorded just 30 procedures in 11 years
By region, the Southeast accounted for 52 percent of all hospitalizations, the South for 23.7 percent, the Northeast for 21.9 percent, and the Centre-West for 2.3 percent. The North managed just 30 hospitalizations over the entire period, or 0.2 percent of the national total. Of those, 20 were in Rondônia, eight in Pará, one in Roraima, and one in Tocantins. Acre, Amazonas, and Amapá recorded none.
SUS data on patient residence tells a different story. Among northern residents, 181 hospitalizations were recorded over the same period, six times the 30 procedures carried out inside the region itself. For residents of Acre, Amazonas, and Amapá, all 65 of their combined hospitalizations took place in other states.
Monsignore said the situation in the North involves considerable distances, difficult transportation, costs for families, the need to stay in another city, and the challenge of follow-up care after the procedure. He said the figures do not necessarily mean every state must immediately set up a complete service, but they point to the need for macro-regional centers, adequate financing, health transportation, and formal patient-transfer arrangements between states.
Growth over a decade, but gaps persist
Annual hospitalizations for chemoembolization rose from 968 in 2015 to a peak of 1,528 in 2024 before falling to 1,304 in 2025, a 34.7 percent increase over the full period. Numbers dipped in 2020, the first year of the Covid-19 pandemic.
Mello said the increase may be linked to greater availability of the technique and to better training of professionals able to identify and refer suitable patients. Monsignore called the trend positive but said it remains insufficient given Brazil’s size and the incidence of liver cancer.
Both specialists stressed that performing chemoembolization requires more than an angiograph machine. A hospital needs interventional radiologists, anesthesiologists, nursing and radiology staff, a pharmacy equipped to prepare the drugs, catheterization and embolization materials, an inpatient unit, and the capacity to manage complications. Monsignore said what is needed is an assistance, technical, and administrative structure that guarantees correct patient selection, safe execution, and proper follow-up.
Mello, drawing on his experience at a public hospital in São Paulo where the medical team was in place but faced supply shortages, said a lack of supplies substantially limits the procedure in public facilities.
The Ministry of Health told CNN Brasil it has been expanding oncology services through the Agora Tem Especialistas program, established by law in October 2025. The ministry said the SUS currently has 319 accredited oncology establishments, including high-complexity centers known as CACONs and UNACONs, distributed across all regions of the country.