{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T23:50:16Z","timestamp":1792108216346,"version":"4.4.0"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Cardiovasc Intervent Radiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To evaluate the efficacy and safety of balloon-occluded transarterial chemoembolization (B-TACE) compared with conventional (cTACE) and drug-eluting-bead transarterial chemoembolization (DEB-TACE) in patients with hepatocellular carcinoma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>A systematic review and meta-analysis was conducted following PRISMA guidelines and registered in PROSPERO. PubMed, Scopus, and the Cochrane Central Register of Controlled Trials were searched to 8 February 2026 for randomized and observational studies comparing B-TACE with cTACE or DEB-TACE. Tumor response (mRECIST), overall survival, and adverse events were pooled using random-effects models; risk of bias was assessed with established tools.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Nine studies (one randomized, eight observational; 1534 patients) were included. Complete response, objective response, disease control, and progressive disease did not differ significantly between groups, with moderate-to-substantial heterogeneity. Baseline tumors were larger in the balloon-occluded group (mean difference 4.34\u00a0mm; 95% CI 1.18- 7.50;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.014). Exploratory study-level analyses suggested greater relative B-TACE effects with larger tumors, particularly for complete response and disease control.Overall survival favored B-TACE in the two studies with extractable hazard ratios (HR 0.41; 95% CI 0.23 to 0.73;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.002). Post-treatment liver enzymes, bilirubin, fever, and post-embolization syndrome did not differ significantly.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>No statistically significant differences in imaging response or safety were observed between intervention and comparator groups, while B-TACE was associated with a signal toward improved overall survival despite larger baseline tumors. Exploratory findings suggested that larger tumor size may be associated with a greater relative B-TACE effect. Given the limited evidence, these findings require confirmation in randomized controlled trials.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00270-026-04645-7","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T23:21:40Z","timestamp":1792106500000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Balloon-Occlusion Versus End-Hole Transarterial Chemoembolization for Hepatocellular Carcinoma: A Systematic Review and Meta-analysis"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-1334-2636","authenticated-orcid":false,"given":"Salvatore","family":"Tumolo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0285-0144","authenticated-orcid":false,"given":"Afonso Quelhas","family":"Fonseca","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3201-8024","authenticated-orcid":false,"given":"Vincenzo","family":"Vingiani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3044-8474","authenticated-orcid":false,"given":"Tiago","family":"Bilhim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1373-6305","authenticated-orcid":false,"given":"H\u00fcseyin Saygin","family":"Tuna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,15]]},"reference":[{"issue":"3","key":"4645_CR1","doi-asserted-by":"publisher","first-page":"209","DOI":"10.3322\/caac.21660","volume":"71","author":"H Sung","year":"2020","unstructured":"Sung H, Ferlay J, Siegel RL, et al. 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To preserve editorial independence, he will be recused from all editorial handling of, and decisions on, this manuscript. The remaining authors (Salvatore Tumolo, Afonso Quelhas Fonseca, Vincenzo Vingiani, H\u00fcseyin Saygin Tuna) declare that they have no conflicts of interest.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This work is a systematic review and meta-analysis of previously published, aggregate data and did not involve any new studies of human participants or animals performed by the authors; accordingly, institutional review board approval was not required.","order":2,"name":"Ethics","label":"Ethical Approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable (review of previously published data).","order":3,"name":"Ethics","label":"Consent for Publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable (review of previously published data).","order":4,"name":"Ethics","label":"Informed Consent","group":{"name":"EthicsHeading","label":"Declarations"}}]}}