Ces radiol. 2024, 78(4):208-213 | DOI: 10.55095/CesRadiol2024.028

Balloon-occluded chemoembolization of hepatocellular carcinoma - method presentation and first experienceOriginal article

Tomáš Tůma^{1, 2}, Petr Hříbek^{2, 3}, Tomáš Koutný¹, Jozef Malík¹, František Charvát¹, Tomáš Belšan¹, Jiří Lacman¹, Tomáš Kupsa², Petr Urbánek³

¹ Radiodiagnostické oddělení, pracoviště intervenční radiologie, Ústřední vojenská nemocnice - Vojenská fakultní nemocnice, Praha

² Katedra vojenského vnitřního lékařství a vojenské hygieny, Vojenská lékařská fakulta, Univerzita obrany, Hradec králové

³ Interní klinika 1. LF UK a Ústřední vojenská nemocnice - Vojenská fakultní nemocnice, Praha

Hepatocellular carcinoma (HCC) is the most common primary malignant liver tumor. In the vast majority of cases, it develops in the field of pre-existing chronic liver disease in the stage of liver cirrhosis. It is a disease with a highly unfavorable prognosis. Unlike other solid tumors, staging in patients with liver cirrhosis is carried out according to Barcelona classification (BCLC) (1). This includes not only the extent of tumor involvement, but also the functional status of the liver and the overall performance status of the patient. Transarterial chemoembolization is the standard of therapy for intermediate-stage HCC (1). A modern modification of this method is balloon-occluded chemoembolization (B-TACE). B-TACE is a method based on temporary balloon occlusion of the supply artery leading to redistribution of flow towards the tumor and thus higher concentration of the embolizate in the target lesion. Increased accumulation of embolization particles leads to more pronounced necrosis of the tumor and thus a better oncological response to treatment. A side effect of the temporary occlusion of the artery is an increase in the safety profile of the procedure due to the prevention of backflow of embolizate and low non-target embolization. At our workplace B-TACE has been performed on 15 patients. The average age of the patients was 73 years. Nine patients had disease stage 0+A and six patients had stage B according to BCLC. The average Child-Pugh score was 5.7 points. Totally 21 HCC nodules were treated (median size 37 mm). After the initial B-TACE, a complete response was achieved in 16 nodules (76%), a partial response in 5 nodules (24%).

There was no serious post- nor periprocedural complication of the procedure. There was no death within 90-day follow-up.

B-TACE appears to be a highly effective method of locoregional therapy for HCC with a favorable safety profile in selected patients and achieves high frequency of complete responses after first cycle of B-TACE.

Keywords: balloon-occluded chemoembolization, hepatocellular carcinoma, liver cirrhosis, locoregional treatment, transarterial chemoembolization.

Accepted: September 15, 2024; Published: December 12, 2024  Show citation