Aim:The goal of the study was to evaluate the efficacy and safety of balloon-occluded transarterial chemoembolization (B-TACE) of hepatocellular carcinoma (HCC) using miriplatin (a lipophilic anticancer drug) and gelatin particles.Methods: B-TACE was performed for 62 HCC nodules in 33 patients who could not be treated by surgical resection or radiofrequency ablation. All 33 patients had a history of transarterial chemoembolization (TACE) treatment prior to B-TACE. As a historical comparison, we investigated 40 nodules in 28 patients treated by TACE using a conventional microcatheter (C-TACE), miriplatin and gelatin particles. The therapeutic effect per tumor was compared between the groups based on the Response Evaluation Criteria in Cancer Study Group of Japan (RECICL) and side-effects were compared based on the Common Terminology Criteria for Adverse Events (ver. 4.0). Results:The therapeutic efficacy after 4-12 weeks was evaluated in 59 nodules in the B-TACE group and in 37 nodules in the C-TACE group. Of these nodules, TE4 occurred in 29 (49.2%) in the B-TACE group and in 10 (27%) in the C-TACE group. Local efficacy was significantly higher in nodules treated by B-TACE than by C-TACE. The side-effects on hepatic function were similar in the two groups. Conclusion:Our results suggest that B-TACE with miriplatin is a useful treatment for hepatocellular carcinoma.

Quantitative image analysis for ultrasonic images of hepatic nodules may correlate with subjective judgment in predicting malignancy.

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We report unusual 2 cases treated with Balloon-occluded transarterial chemoembolization (B-TACE) for peritoneal hepatocellular carcinoma (HCC) metastasis. An 87-year-old female with hepatitis-C related cirrhosis underwent radiofrequency ablation (RFA) repeatedly. Computed tomography showed a 30 mm diameter tumor seeding adjacent to the ascending colon. Digital subtraction angiography (DSA) of the gastroduodenal artery showed a tumor stain fed by an omental arterial branch distributing from the greater curvature of the stomach. Since ultra-selective cannulation was difficult, a micro-balloon catheter was selected and advanced to the right gastroepiploic artery on the central side of the omental artery, and B-TACE was performed at this point. A 78-yearold male with hepatitis-C related cirrhosis underwent RFA and TACE repeatedly, but multiple HCC developed and a 45 mm diameter metastatic tumor adjacent to the descending colon was observed. DSA of the inferior mesenteric artery showed a tumor stain fed by the several peripheral branches of the left colic artery. Since one of this several branches was noted the normal mesenteric blood vessel by selective angiography, the position of the tip of the micro-balloon catheter was finely adjusted by balloon inflation to prevent inflow of the contrast medium into the normal blood vessel, and then B-TACE was performed.

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