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World J Hepatol. Jul 27, 2018; 10(7): 485-495
Published online Jul 27, 2018. doi: 10.4254/wjh.v10.i7.485
Balloon-occluded transcatheter arterial chemoembolization for hepatocellular carcinoma
Takeshi Hatanaka, Hirotaka Arai, Satoru Kakizaki
Takeshi Hatanaka, Department of Gastroenterology, Saiseikai Maebashi Hospital, Gunma 371-0821, Japan
Hirotaka Arai, Department of Gastroenterology, Maebashi Red Cross Hospital, Gunma 371-0014, Japan
Satoru Kakizaki, Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Gunma 371-8511, Japan
Author contributions: All authors have contributed to the study concept, data analyzing, manuscript writing, editing and approval of the final manuscript for publication.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Satoru Kakizaki, MD, PhD, Associate Professor, Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Showa-machi, 3-39-15, Maebashi, Gunma 371-8511, Japan. kakizaki@gunma-u.ac.jp
Telephone: +81-27-2208127 Fax: +81-27-2208136
Received: March 27, 2018
Peer-review started: March 27, 2018
First decision: April 11, 2018
Revised: June 24, 2018
Accepted: June 28, 2018
Article in press: June 28, 2018
Published online: July 27, 2018
Abstract

Transcatheter arterial chemoembolization (TACE) is widely accepted as a treatment for patients with hepatocellular carcinoma (HCC) in the intermediate stage according to the Barcelona Clinic Liver Cancer (BCLC) guidelines. Recently, balloon-occluded TACE (B-TACE) was developed in Japan. Despite the lack of a clear definition, B-TACE is generally defined as the infusion of emulsion of chemotherapeutic agents with lipiodol followed by gelatin particles under the occlusion of feeding arteries by a microballoon catheter, which leads to the dense lipiodol emulsion (LE) accumulation in HCC nodules. This phenomenon cannot be explained only by the prevention of proximal migration and leakage of embolization materials; it further involves causing local changes in the hemodynamics of the surrounding occlusion artery and targeted HCC nodules. Balloon-occluded arterial stump pressure plays an important role in the dense LE accumulation in targeted HCC nodules. Although randomized controlled trials comparing the therapeutic effect and the prognosis of B-TACE to those of the other TACE procedures, such as conventional-TACE and drug-eluting beads TACE, are still lacking, B-TACE is thought to be a promising treatment. The purpose of this review is to summarize the mechanism, therapeutic effect, indication, prognosis and complications of B-TACE.

Keywords: Hepatocellular carcinoma, Treatment effect, Transcatheter arterial chemoembolization, Prognosis, Balloon-occluded arterial stump pressure, Dense lipiodol emulsion accumulation, Balloon-occluded transcatheter arterial chemoembolization, Microballoon catheter

Core tip: Balloon-occluded transcatheter arterial chemoembolization (B-TACE) was recently developed in Japan. Despite the lack of a clear definition, B-TACE is generally defined as the infusion of emulsion of chemotherapeutic agents with lipiodol followed by gelatin particles under the occlusion of feeding arteries by a microballoon catheter. Although randomized controlled trials comparing the therapeutic effect and the prognosis of B-TACE to those of the other TACE procedures are still lacking, B-TACE is thought to be a promising treatment. The purpose of this review is to summarize the mechanism, therapeutic effect, indication, prognosis and complications of B-TACE.