Optimizing Hepatocellular Carcinoma Management: The Role of Balloon-Occluded Transarterial Chemoembolization

Hepatocellular carcinoma (HCC) is the most common primary liver cancer and a leading cause of cancer-related deaths worldwide, with over 900,000 new cases each year. Many patients are diagnosed at an intermediate BCLC stage, when curative measures such as liver transplantation, bridge therapy, liver cancer ablation, or surgery are not practical. For these patients, transarterial chemoembolization (TACE) offers a targeted, loco-regional therapy option that attacks the tumor while preserving healthy liver tissue.

Challenges in HCC Management

Patients with HCC may have multiple tumors and impaired liver function, making care challenging. For optimal outcomes, a thorough assessment of liver function, ECOG performance status, tumor size, number, and vascular involvement (e.g., portal vein thrombosis) is required. In clinical practice, preserving the liver while controlling tumors is a never-ending struggle.

Conventional TACE vs BTACE

The TACE procedure delivers chemotherapy directly to the tumor while blocking its blood supply. For patients with BCLC stage B disease and good ECOG performance status (0–1), this approach can be lifesaving. Yet conventional TACE (cTACE) has limits : drug distribution can be uneven, tumors may not get fully treated, and repeated sessions can affect liver function.Balloon-occluded TACE (B-TACE) builds on the strengths of cTACE, offering improved tumor penetration and more consistent drug delivery, resulting in higher overall and complete tumor response rates.

BTACE as an Advancement and How It Improves TACE Treatment

Ballon occluded transarterial chemoembolization (BTACE) represents an important advancement over conventional TACE.It is defined as the infusion of a chemotherapeutic–lipiodol emulsion, followed by gelatin particles, under occlusion of the feeding arteries by a microballoon catheter. This results in reduced arterial stump pressure, collateral flow opening, and flow redistribution, allowing more selective drug delivery to the tumor.

By inflating a balloon in the hepatic artery, balloon-occluded TACE (B-TACE) redirects blood flow to prolong and enhance the effects of chemotherapy on the tumor. This temporary occlusion lowers the arterial stump pressure (BOASP ≤64 mmHg), allowing lipiodol or drug-eluting beads to penetrate deeper into the tumor vasculature. Double-balloon microcatheters may further improve embolic delivery.

B-TACE offers better tumor response than cTACE.According to recent a study of 1,166 patients, BTACE showed higher tumor response than conventional TACE: overall response rates were 96% vs. 79%, and complete response rates ranged from 63–68% with BTACE compared to 53% for conventional TACE. These advantages were achieved without an increase in severe side effects, although post-embolization syndrome was somewhat more common but still manageable.

Who Benefits Most?

Careful patient selection is key to optimizing B-TACE benefits. Ideal candidates have Child-Pugh A or early B liver function, ECOG 0–1, intermediate BCLC stage with multinodular disease, and no significant portal vein thrombosis. BTACE may also be used in recurrent HCC, as a bridge to liver transplantation, or with systemic therapy for HCC and ablation of liver cancer.

Safety & Monitoring

B-TACE is generally well tolerated, but careful monitoring of liver function and post-embolization syndrome remains essential. Multidisciplinary teams in interventional oncology have a key role in providing safe and effective treatment.

Conclusion

BTACE is a meaningful evolution of TACE, improving tumor response while maintaining safety. For the carefully selected patients, it can make a real difference in outcomes.

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References

  1. Foglia B, Turato C, Cannito S. Hepatocellular Carcinoma: Latest Research in Pathogenesis, Detection and Treatment. Int J Mol Sci. 2023;24(15):12224. Published 2023 Jul 31.
  2. Sharma M, Kannan D, Shahanas SM, Dhus U, Kumar R. Exploring the Etiology and Management of Intermediate Stage Hepatocellular Carcinoma in a Tertiary Care Center in South India. Gastroenterology, Hepatology and Endoscopy Practice. 2025 Apr 1;5(2):57-60.
  3. Golfieri R, Bargellini I, Spreafico C, Trevisani F. Patients with Barcelona Clinic Liver Cancer Stages B and C Hepatocellular Carcinoma: Time for a Subclassification. Liver Cancer. 2019 Mar;8(2):78-91.
  4. Shehta A, Elsabbagh AM, Medhat M, Farouk A, Monier A, Said R, Salah T, Elshobari M, Fouad A, Elghawalby AN. Impact of tumor size on the outcomes of hepatic resection for hepatocellular carcinoma: a retrospective study. BMC Surg. 2024 Jan 3;24(1):7.
  5. Fite EL, Makary MS. Transarterial Chemoembolization Treatment Paradigms for Hepatocellular Carcinoma. Cancers (Basel). 2024 Jul 1;16(13):2430.
  6. Liu J, Wang W, Zhai H, Ma Y, You Q, Shao H. Balloon-occluded versus conventional transarterial chemoembolization for the treatment of early to intermediate stage hepatocellular carcinoma: a meta-analysis and trial sequential analysis. BMC Cancer. 2025 Jul 1;25(1):1036.
  7. Lanza C, Ascenti V, Amato GV, Pellegrino G, Triggiani S, Tintori J, Intrieri C, Angileri SA, Biondetti P, Carriero S, et al. All You Need to Know About TACE: A Comprehensive Review of Indications, Techniques, Efficacy, Limits, and Technical Advancement. Journal of Clinical Medicine. 2025; 14(2):314. https://doi.org/10.3390/jcm14020314
  8. Hatanaka T, Arai H, Kakizaki S. Balloon-occluded transcatheter arterial chemoembolization for hepatocellular carcinoma. World J Hepatol. 2018 Jul 27;10(7):485-495.
  9. Liu J, Wang W, Zhai H, Ma Y, You Q, Shao H. Balloon-occluded versus conventional transarterial chemoembolization for the treatment of early to intermediate stage hepatocellular carcinoma: a meta-analysis and trial sequential analysis. BMC Cancer. 2025 Jul 1;25(1).
  10. Azam F, Latif MF, Farooq A, Tirmazy SH, AlShahrani S, Bashir S, Bukhari N. Performance Status Assessment by Using ECOG (Eastern Cooperative Oncology Group) Score for Cancer Patients by Oncology Healthcare Professionals. Case Rep Oncol. 2019 Sep 25;12(3):728-736.
  11. Yao, Yanrong, et al. “Summary of the Evidence of Best Practices for the Prevention and Treatment of Embolism Syndrome after TACE in Primary Liver Cancer.” Frontiers in Oncology, vol. 13, Jan. 2024. Frontiers, https://doi.org/10.3389/fonc.2023.1274235.
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