Transarterial Chemoembolization with and without Microballoon Occlusion for Hypovascular Hepatocellular Carcinoma

An 85-year-old woman developed locally recurrent hepatocellular carcinoma (HCC) after previous radiofrequency ablation combined with transarterial chemoembolization (TACE). Dynamic computed tomography (CT) and magnetic resonance imaging revealed a hypovascular tumor, which was suspected as poorly differentiated HCC. TACE was performed using a microballoon catheter. First, a suspension of miriplatin mixed with iodized oil (miriplatin-lipiodol suspension [MLS]) was injected without balloon occlusion. When the tumor-feeding artery was near stasis, the balloon was inflated and MLS was forcefully injected. CT after TACE showed accumulation of iodized oil throughout the tumor. The tumor had been controlled without recurrence for 22 months, at the time of writing this manuscript. The therapeutic efficacy of conventional TACE (C-TACE) for poorly differentiated hypovascular HCC is generally limited. In the present case, a good therapeutic result was achieved when balloon-occluded TACE was used in addition to C-TACE.