Pressure Gradient-Driven Embolization b-TACE for HCC: Technical and Diagnostic Step-by-Step Procedural Guide and
Bianca Rocco1,2, David C Madoff3, Fabrizio Basilico1
1Interventional Radiology UOS, Department of Diagnostic Medicine and Radiology, Sapienza University of Rome, 00161 Rome, Italy.
Insights
Balloon-occluded transarterial chemoembolization (bTACE) enhances chemotherapy delivery for intermediate-stage hepatocellular carcinoma (HCC). This advanced technique improves treatment response and patient outcomes in HCC management.
Area of Science:
- Interventional Radiology
- Hepatobiliary Oncology
- Transarterial Therapies
Background:
- Hepatocellular carcinoma (HCC) is a major global cause of cancer mortality.
- Transarterial therapies are crucial for managing HCC, particularly intermediate-stage disease.
- Standard transarterial chemoembolization (TACE) efficacy is limited by tumor size and achieving complete response.
Purpose of the Study:
- To introduce and detail the balloon-occluded transarterial chemoembolization (bTACE) technique.
- To highlight bTACE as a novel innovation in transarterial therapies for HCC.
- To provide a guide for optimal procedural execution and patient benefit.
Main Methods:
- Utilizing a microballoon catheter for pressure gradient-driven embolization.
- Implementing bTACE to achieve targeted redistribution of chemotherapeutic agents.
- Reviewing existing literature to support the technical guide.
Main Results:
- bTACE facilitates higher intratumoral drug concentrations.
- Improved flow redistribution towards tumor territories is achieved.
- Enhanced oncological performance is expected, especially in challenging cases.
Conclusions:
- bTACE represents a significant advancement in transarterial HCC treatment.
- This technique offers improved outcomes compared to standard TACE.
- A step-by-step guide enables optimal bTACE procedures for maximum clinical benefit.
Abstract:
Background: Hepatocellular carcinoma (HCC) is one of the leading cause of cancer death worldwide. Transarterial therapies represent an important tool in the management of different clinical scenarios, from a patient with a single nodule to a patient with multinodular disease. Up to 30% of patients are diagnosed with intermediate-stage HCC, and transarterial chemoembolization (TACE) represents the mainstay of treatment. Overall survival in patients with HCC undergoing TACE is strongly influenced by obtaining a sustained complete response, which is strongly affected by the HCC's dimension. Methods: Pressure gradient-driven embolization, achieved by employing a microballoon catheter in the balloon-occluded TACE (bTACE), represents the most novel innovation in the field of transarterial therapies in the last decade. In fact, bTACE, thanks to its ability to redistribute flow towards tumor territories, can allow higher chemotherapeutic drug concentrations, leading to better oncological performance, especially in patients in which standard TACE struggles to obtain a complete response. Conclusions: This technical and diagnostic intraprocedural step-by-step guide, discussed with a review of the existing literature, will enable readers to achieve an optimal procedure and to convey to their patients the full clinical benefits of these procedures.
