Microballoon Interventions for Liver Tumors: Review of Literature and Future Perspectives

Abstract

Background: Microballoon interventions (MBIs) have been proposed as useful tools to improve the efficacy of locoregional liver treatments. The aim of this systematic review was to summarize the existing evidence on procedural characteristics, safety, and efficacy of MBIs. Methods: PubMed and Cochrane Central Register of Controlled Trials were queried for original research articles evaluating MBIs in patients with liver malignancies from 2012 to August 2022. Search terms employed were liver malignancies, hepatocellular carcinoma, cholangiocarcinoma, liver metastases, microballoon transarterial chemoembolization, balloon-occluded trans-arterial chemoembolization, balloon-occluded selective internal radiation therapies, balloon-occluded TACE and ablation, and safety or oncological results or efficacy. Merely technical studies and animal studies were excluded. Results: Thirty-four original research studies and one abstract involving 744 patients treated with MBIs were included; 76% of the studies were retrospective, with low risk of bias and moderate-to-poor levels of evidence. Heterogeneity precluded meta-analysis. All studies proved MBI safety, which was not inferior to non-occlusive procedures. Balloon employment ameliorates oncological results, improving time to recurrence, objective response rate, and lowers need for retreatment. Conclusions: MBIs appear to be potential game changers in the treatment of liver malignancies. Multicentric, prospective and randomized studies are necessary to confirm these findings.

Combined treatments with microballoon catheters and multiple cryoablation probes for shoulder-subclavian soft tissue hemangiopericytoma: A case report

“…To date, the only reported complication directly related to microballoon use has been vascular dilatation at the balloon inflation site. In all reported cases, this event was asymptomatic and was revealed during routine follow-up with contrast-enhanced CT and required no further treatment [7] .…”

“…Balloon microcatheter intervention had been described in liver chemoembolization for Hepatocellular Carcinoma [7 , 8] . Reported advantages of this technique are reversal of the flow of collateral arteries, reduction in the number of superselective catheterizations, and improvement of results on larger nodules in a single session.…”

Local Recurrence following Radiological Complete Response in Patients Treated with Subsegmental Balloon-Occluded Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma

“…Regarding safety, no studies have reported a significant difference in the rate of complications between procedures performed with and without balloon occlusion [15][16][17][18][19][20][21]. B-TACE has been demonstrated to be safe, with an adverse event rate equivalent to that of C-TACE.…”

“…Balloon-occluded transcatheter arterial chemoembolization (B-TACE), in which a microballoon catheter is used to temporarily occlude the tumor feeding artery, was introduced to increase CR rates [13,14]. Although no definitive indications for B-TACE have been established to date, several studies have reported that initial tumor responses are better among patients with HCC who undergo B-TACE than other TACE techniques, including conventional TACE (C-TACE) and drug-eluting bead TACE [15][16][17][18][19][20][21]. However, assessing the quality of CR in terms of the therapeutic outcomes of B-TACE is necessary because the evaluation of LR may provide more detailed information on the ability of the B-TACE to result in a local cure.…”