Balloon-occluded transcatheter arterial chemoembolization for hepatocellular carcinoma

Hatanaka, Takeshi; Arai, Hajime; Kakizaki, Satoru

doi:10.4254/wjh.v10.i7.485

Cited by 43 publications

(48 citation statements)

References 57 publications

(141 reference statements)

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“…The Sniper balloon occlusion catheter was also used to regulate flow. Balloon-occluded transcatheter arterial chemoembolization (B-TACE) is an interventional approach that utilizes the infusion of lipiodol (an ethiodized oil) followed by gelatin particles under the occlusion of feeding arteries by a balloon catheter [9]. Using balloon occlusion, the Sniper microcatheter system created a low-pressure gradient at the proximal GDA, forcing blood flow towards the GDA and preventing reflux.…”

Section: Resultsmentioning

confidence: 99%

Conventional Transarterial Chemoembolization (TACE) of a Hepatocellular Carcinoma with Aberrant Extrahepatic Blood Supply using Balloon Microcatheter for Flow Redirection

Kumar¹

2019

CRIJ

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Hepatocellular carcinoma (HCC) is a malignant tumor that commonly affects cirrhotic patients. For tumors with a Barcelona Clinic Liver Cancer (BCLC) stage B, locoregional therapy is the mainstay of treatment. Transarterial chemoembolization (TACE) utilizes the hepatic arterial network in localizing chemotherapy to the HCC. 80% of HCC cases are primarily supplied by the hepatic artery and most have extrahepatic collaterals from the inferior phrenic artery. This is the first reported case where the gastroduodenal artery (GDA) was the primary and sole blood supply to the HCC. The patient's levels for AST, ALT, hemoglobin, bilirubin, albumin, PT/INR, and platelets were all within normal range. The initial MRI showed a single exophytic tumor located on the caudate lobe. According to the BCLC staging system, the tumor was determined to be in the intermediate stage and TACE was considered to be the appropriate treatment. The right gastroepiploic artery was first occluded with detachable coils. Subsequently, a 150 cm straight 2.9FrSniper balloon microcatheter was introduced into the proximal GDA. TACE was performed using balloon occlusion to redirect blood flow away from the feeder arteries to the duodenum and into the blood supply to the tumor. One-month follow-up MRI scans showed reduction in the size of the HCC.

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Section: Resultsmentioning

confidence: 99%

Conventional Transarterial Chemoembolization (TACE) of a Hepatocellular Carcinoma with Aberrant Extrahepatic Blood Supply using Balloon Microcatheter for Flow Redirection

Kumar¹

2019

CRIJ

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“…This technical bene t should theoretically enhance the ability to locally control tumor growth. Despite this, literature evidence on oncological response of b-TACE over standard non occluded TACE is controversial [3][4][5][6] In order to evaluate the adjunctive value of b-TACE we retrospectively evaluated the results of patients treated in our institution with b-TACE and compared them with an historical cohort treated with non-occluded DEM-TACE. b-TACE and DEM-TACE were performed by the same team under dual phase CBCT guidance i.e..: better tumor/feeders visualization) 15 , with rigorous standardization of the embolization procedure (sequential embolization with 100 and 200 microns particles 12 ), being the only technical variable the balloon micro-catheter employment.…”

Section: Discussionmentioning

confidence: 99%

“…To date there are no randomized controlled trials comparing TACE to b-TACE in terms of oncological response; moreover, some retrospective studies reported con icting results. 3 Ogawa et a l 4 and Irie et al 5 showed a better tumor response for b-TACE performed with Lipiodol in comparison to Lipiodol TACE performed with a standard catheter. Maruyama et al 6 , on the other hand, failed to demonstrate a difference in tumor control between the two techniques.…”

Section: Introductionmentioning

confidence: 96%

Balloon Occluded TACE (B-TACE) vs DEM-TACE for HCC. A Single Center Retrospective Case Control Study.

Lucatelli

Rubeis

Rocco

et al. 2020

Preprint

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Background To compare oncological results and safety profile of balloon micro-catheter trans-arterial chemoembolization (b-TACE) and drug-eluting-microsphere (DEM-TACE) in patients with hepatocellular-carcinoma (HCC).Methods This is a case-control, retrospective, single-center study. Between January-2015/March-2019, 149 patients (131 males [87.9%]) with 226 HCC were treated, 22 patients (35 HCC; 19 [86.4%] males) with b-TACE and 127 with DEM-TACE (191 HCC, 112 [88.2%] males). Embolization protocol was standardized (sequential 100±25 and 200±25 μm microspheres). Results were evaluated by modified-response-evaluation-criteria-in-solid-tumor [mRECIST] at 1, 3-6 and 9-12 months and time to recurrence after complete response [TTR] at 1 years. Cox’s regression weighted with tumor dimensions was performed. Adverse events (AEs) were recorded.Results mRECIST oncological response at all time points (1, 3-6 and 9-12 months) for both treatments were similar, with the exception of Objective response rate at 9-12months. Objective response at 1 and 3-6 months between b-TACE vs DEM-TACE [23/35 (65.7%) vs 119/191 (62.3%), 21/29 (72.4%) vs 78/136 (57.4%) (p>0.05), respectively]. On the contrary, at 9-12 months, it was significantly higher in b-TACE subgroup than DEM-TACE (15/19 [78.9%] vs 48/89 [53.9%], p=0.05). TTR for complete response at 1 year had a better trend for b-TACE vs DEM-TACE (278.0 days [196.0-342.0] vs 219.0 days [161.0-238.0], OR 0.68 [0.4-1.0], p=0.10). The use of balloon micro-catheter reduced the relative risk of the event of recurrence by 0.63 [CI95% 0.38-1.04]; p=0.07). No significant differences were found in AEs rate. Conclusion b-TACE showed a trend of better oncological response over DEM-TACE with and longer TTR with a similar adverse events rate, in patients presenting with larger tumors.

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“…A good review paper about clinical results of SSLB-TACE is available. 22 Although SSLB-TACE is thought to be a promising technique, randomized prospective controlled trials to compare local control rates with c-TACE are still lacking.…”

Section: Indication Of Sslb-tacementioning

confidence: 99%

Balloon-occluded transarterial chemoembolization for hepatocellular carcinoma: History, background, and the roles

Irie

Takahashi

Hoshiai

2020

Int J Gastrointest Interv

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Super-selective lipiodol balloon-occluded transarterial chemoembolization (SSLB-TACE) increases lipiodol accumulation in the targeted nodule. To understand the mechanism of increased accumulation, it is necessary to understand intra-hepatic collateral system and rheology of lipiodol. Although SSLB-TACE is thought to be a promising technique, randomized prospective controlled trials to compare local control rates with conventional super-selective lipiodol (c-TACE) are still lacking. Another problem for SSLB-TACE is change of TACE candidates by development of radiofrequency ablation (RFA) technology. Patients with limited number of small nodules are good candidates for both SSLB-TACE and c-TACE, but these are also good candidates for RFA. Because higher priority is given to RFA, TACE is usually indicated for patients with 4 or more nodules, with large nodule(s), and/or with proximal Glisson attaching nodule(s). However, these cases are known as TACE-refractory, and the chance to perform SSLB-TACE or c-TACE would be markedly decreased in institutions where RFA is aggressively performed. In the past, paradigm shift from non-selective TACE to super-selective TACE occurred, and the goal of SSLB-TACE and c-TACE is prolonged complete remission of the treated nodules while sacrificing small volume of liver parenchyma. But another TACE technique, aiming treatment of wide region (hemi-lobe or more) and effective tumor volume reduction while minimizing liver parenchymal damage, is mandatory in RFA era. For this purpose, we developed a new balloon-occluded TACE without using lipiodol; alternate infusion of cisplatin solution and sparse gelatin slurry was repeated under balloon-occlusion (RAIB-TACE) until stasis of gelatin slurry in proximal hepatic arteries was seen. However, not only RFA but also recent development of molecular targeted drugs strongly influences on the indication and the aim of TACE. The goal and technique of TACE should be properly selected in each era, in each institution, and for each patient.

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Balloon-occluded transcatheter arterial chemoembolization for hepatocellular carcinoma

Cited by 43 publications

References 57 publications

Conventional Transarterial Chemoembolization (TACE) of a Hepatocellular Carcinoma with Aberrant Extrahepatic Blood Supply using Balloon Microcatheter for Flow Redirection

Conventional Transarterial Chemoembolization (TACE) of a Hepatocellular Carcinoma with Aberrant Extrahepatic Blood Supply using Balloon Microcatheter for Flow Redirection

Balloon Occluded TACE (B-TACE) vs DEM-TACE for HCC. A Single Center Retrospective Case Control Study.

Balloon-occluded transarterial chemoembolization for hepatocellular carcinoma: History, background, and the roles

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