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Balloon-Occluded Transarterial Chemoembolization for Hepatocellular Carcinoma: Technical Rationale, Current Evidence, and Future Directions.

Created on 02 Sep 2026

Authors

Xiaoli Jia, Yuanyi Chen, Xiaomeng Cui, Yan Tian, Dandan Feng, Wenjun Wang

Published in

Journal of hepatocellular carcinoma. Volume 13. Pages 622393. Epub Aug 28, 2026.

Abstract

Balloon-occluded transarterial chemoembolization (B-TACE) uses temporary microballoon occlusion to reduce distal arterial pressure and promote dense, selective deposition of chemoembolic material within the tumor and its drainage territory. Observational comparative studies and a meta-analysis suggest higher complete response and objective response rates than conventional TACE (C-TACE), especially in 3-5 cm tumors. However, randomized evidence and a proven survival advantage are lacking. Clinical benefit is therefore most plausible in carefully selected patients with preserved liver function, a limited tumor burden amenable to segmental treatment, and anatomy in which collateral inflow does not prevent a meaningful pressure reduction. Measurement of balloon-occluded arterial stump pressure may help characterize hemodynamics, but the proposed <64 mmHg threshold is not universally reproducible or routinely available. B-TACE has a broadly comparable overall safety profile to C-TACE, while non-target or excessive peripheral embolization can injure the peribiliary plexus and cause biloma or hepatic abscess. Future priorities include standardized technical endpoints, prospective randomized comparisons, validated selection criteria, imaging-based hemodynamic prediction, and rigorously designed combinations with systemic or other locoregional therapies.

PMID:
42683464
Bibliographic data and abstract were imported from PubMed on 02 Sep 2026.

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