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Balloon-Occluded Transarterial Chemoembolization: In which size range does it perform best? A comparison of its efficacy versus conventional Transarterial Chemoembolization, using Propensity score matching

​Golfieri R. Bezzi M. · Verset G. Fucilli F. Mosconi C.  Cappelli A. Paccapelo A. Lucatelli P. Magand N. Rode A. De Baere T.

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28/08/2023 -  

​Background

To further advance effectiveness of TACE, the balloon-occluded TACE (B-TACE) was introduced in 2009; the B-TACE procedure is performed using a balloon microcatheter inflated within the tumor-feeding arteries during selective/superselective TACE. 

Objective
The aim of this study was to investigate the size ranges in which cTACE and B-TACE could offer more benefits in terms of CR rates after the first session, and exploring a possible reduction in the need for re-treatment (according to the on-demand treatment strategy).
 
Methods

  • The B-TACE study population included 91 patients (179 nodules), affected by HCC, early or intermediate-stage who had undergone either cTACE or DEM-TACE.
  • The control group included 234 patients (445 nodules), taken from a historical institutional database and having similar characteristics, who underwent selective/superselective cTACE using a conventional microcatheter.
  • The results were compared according to tumor size: (A) <30 mm, (B) 30–50 mm, and (C) >50 mm; OR and CR rates after the follow up 3-6 months and the number of TACE re-interventions within a 6-month period were also evaluated using propensity score matching (PSM).


Results

  • The best target ORs were very high (93.2%) and similar between the 2 treatments both before (94.4% for cTACE and 90.1% for B-TACE) and after PSM (94.5% for cTACE and 90.1%), with slightly better results for the cTACE.
  • In lesions <30 mm, cTACE obtained a slightly higher CR rate than B-TACE (62.5 vs. 56.3% after PSM).
  • In intermediate-sized HCCs (30–50 mm), B-TACE showed a significant superiority in achieving a CR (71.7 vs. 48.9%, respectively after PSM ).
  • In larger lesions (>50 mm), cTACE and B-TACE performed equally, with a poor CR rate (21.4 vs. 23.1%, respectively after PSM).
  • The patients treated with B-TACE had a significantly lower re-treatment rate than the cTACE cohort (12.1 vs. 26.9%, respectively).
  • B-cTACE and B-DEM-TACE demonstrated similar ORs, with a slightly better CR rate for B-cTACE (68.2 vs. 56.5%, respectively). 


Conclusion
In HCCs of 30–50 mm, B-TACE should be preferred to cTACE, whereas in smaller nodules (<30 mm), cTACE can suffice in achieving a good CR rate.

Key Takeaways
  • In small lesions (<30 mm), cTACE can suffice since it performs very well, with similar rates of CRs when compared to B-TACE. 
  • In lesions between 30 and 50 mm, B-TACE should be chosen since it outperformed cTACE in CR rates.
  • In lesions >50 mm, B-TACE and cTACE perform equally, in this size range, a combination strategy is warranted. 
  • Regardless of the dimensional range, patients undergoing B-TACE had a benefit in terms of lower re-treatment rates when compared to standard cTACE, which could help in preserving liver function and in reducing rehospitalizations for re-treatments.

Link to the full publication: https://www.karger.com/Article/FullText/516613