Pierleone Lucatelli, Gianluca De Rubeis, Bianca Rocco, Fabrizio Basilico, Alessandro Cannavale, Aurelio Abbatecola, Pier Giorgio Nardis, Mario Corona, Stefania Brozetti, Carlo Catalano and Mario Bezzi

​Lucatelli et al. BMC Gastroenterology(2021)  ​

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At the time of publication, scarse evidence was available for B-TACE vs TACE, hence the authors reported data from a single center retrospective experience.

To compare oncological results and safety profile of balloon micro-catheter trans-arterial chemoembolization (B-TACE) and drug-eluting-microsphere (DEM-TACE) in patients with hepatocellular-carcinoma (HCC).

• 149 patients (131 males [87.9%]) with 226 HCC were treated, 22 patients (35 HCC; 19 [86.4%] males) with B-TACE and 127 with DEM-TACE (191 HCC, 112 [88.2%] males).
• Inclusion criteria were: Child–Pugh score up to B8, Barcelona Clinic Liver Cancer (BCLC) stage A and B, not eligible for curative treatments.
• Embolization protocol was standardized (sequential 100 ± 25 and 200 ± 25 μm microspheres).
• Results were evaluated by modified-response-evaluation-criteria-in-solid-tumor [mRECIST] at 1, 3–6 and 9–12 months and time to recurrence after complete response [TTR] at 1 year.

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• mRECIST oncological response at all time points (1, 3–6 and 9–12 months) for both treatments were similar, except Objective response rate at 9-12 months.
• Objective response at 1 and 3–6 months between B-TACE vs DEM-TACE [23/35 (65.7%) vs 119/191 (62.3%), 21/29 (72.4%) vs 78/136 (57.4%)].
• On the contrary, at 9–12 months, it was significantly higher in B-TACE subgroup than DEM-TACE (15/19 [78.9%] vs 48/89 [53.9%]).
• The median follow-up time was 143 days, which is higher in B-TACE comparing with DEM-TACE.
• TTR for complete response at 1 year had a better trend for B-TACE vs DEM-TACE (278.0 days [196.0– 342.0] vs 219.0 days [161.0–238.0], OR 0.68 [0.4–1.0).

• The use of balloon micro-catheter reduced the relative risk of the event of recurrence by 0.63 [CI95% 0.38–1.04]).
• No significant differences were found in AEs rate.

B-TACE showed a trend of better oncological response over DEM-TACE with a longer TTR with a similar adverse events rate, in patients presenting with larger tumors.

• B-TACE had a better objective response at 9–12 months and higher TTR after CR at 1-year in comparison to DEM-TACE, with a similar AEs rate, in patients presenting with larger tumors.
• These findings suggest a potential advantage of B-TACE for patients with larger tumors.