With this potential limitation in mind, in the present review, we describe the current understanding of the mechanism, therapeutic effect, indication, overall survival and complications of B-TACE. Table Table1 1 depicts the key findings of the therapeutic effect and overall survival of B-TACE. In addition, randomized controlled trials (RCTs) comparing the therapeutic effect and the prognosis of B-TACE to those of other TACE procedures are still lacking. The therapeutic effect of B-TACE was better than that of C-TACE according to several previous reports, although those were retrospective and small in scale. The occlusion of the feeding arteries result in the dense lipiodol emulsion (LE) accumulation in targeted nodules. Although it is not mentioned in several guidelines and its clear definition has not been established, it is generally defined as the infusion of emulsion of chemotherapeutic agents with lipiodol followed by gelatin particles under the occlusion of feeding arteries by a microballoon catheter. Recently, balloon-occluded TACE (B-TACE), which was first reported by Irie et al, has been developed in Japan. Conventional-TACE (C-TACE) is defined as the injection of a mixture of anticancer agents with lipiodol followed by embolic materials, such as gelatin particles, calibrated microspheres or polyvinyl alcohol, and drug-eluting beads TACE (DEB-TACE) is defined as the infusion of microspheres onto which chemotherapeutic agents is loaded or adsorbed to achieve a sustained in vivo drug release. TACE is performed through the injection of single or multiple chemotherapeutic agents after the catheterization of tumor-feeding arteries, followed by the embolization of the same vessels in order to gain a synergistic effect of cytotoxicity and ischemia.
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The median survival of untreated patients at the intermediate stage, who present with multinodular without vascular invasion or extrahepatic metastasis, performance status 0 and Child-Pugh class A or B, is reported to be 16 mo, and TACE prolongs their overall survival compared to that of a control group. According to the Barcelona Clinic Liver Cancer (BCLC) guidelines, transcatheter arterial chemoembolization (TACE) is an established treatment for patients with HCC in the intermediate stage. Liver cancer ranks sixth as the common malignant neoplasm and second as the cause of death worldwide, and hepatocellular carcinoma (HCC) is the most common type of malignant liver tumors. The purpose of this review is to summarize the mechanism, therapeutic effect, indication, prognosis and complications of B-TACE. Although randomized controlled trials comparing the therapeutic effect and the prognosis of B-TACE to those of the other TACE procedures, such as conventional-TACE and drug-eluting beads TACE, are still lacking, B-TACE is thought to be a promising treatment. Balloon-occluded arterial stump pressure plays an important role in the dense LE accumulation in targeted HCC nodules. This phenomenon cannot be explained only by the prevention of proximal migration and leakage of embolization materials it further involves causing local changes in the hemodynamics of the surrounding occlusion artery and targeted HCC nodules.
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Despite the lack of a clear definition, B-TACE is generally defined as the infusion of emulsion of chemotherapeutic agents with lipiodol followed by gelatin particles under the occlusion of feeding arteries by a microballoon catheter, which leads to the dense lipiodol emulsion (LE) accumulation in HCC nodules. Recently, balloon-occluded TACE (B-TACE) was developed in Japan. Transcatheter arterial chemoembolization (TACE) is widely accepted as a treatment for patients with hepatocellular carcinoma (HCC) in the intermediate stage according to the Barcelona Clinic Liver Cancer (BCLC) guidelines.