We retrospectively assessed the factors that may impede tumour reduction of locally advanced cervical adenocarcinoma treated with balloon-occluded arterial infusion chemotherapy (BOAI) as initial therapy. We reviewed the medical records and MRI scans of 31 patients (mean age, 54.7 years; age range, 33-78 years). BOAI was performed via uterine arteries in 21 patients, and via the anterior division or main trunk of the internal iliac artery (when the uterine arteries were obscured) in 10 patients. Tumour reduction rate was calculated from the tumour size on MRI before and after BOAI, and patients given chemotherapy were classified as "non-responders" or "responders". Factors including the patient's age, tumour stage (using the International Federation of Gynecology and Obstetrics classification), the artery used for infusion, infused drug, presence of intravenous systemic chemotherapy, initial tumour size, tumour volume and presence of lymph node metastases were assessed for their ability to predict tumour response to BOAI using univariate and multivariate analyses. Patients who underwent chemotherapy included 10 non-responders and 21 responders. The age of non-responders was significantly higher than that of responders (66 years vs 49 years, p<0.001). Internal iliac arterial infusion significantly correlated with "no response" compared with uterine arterial infusion (p<0.001). In multivariate analyses, internal iliac arterial infusion was an independent predictor for BOAI non-responders (odds ratio, 19.6; 95% confidence interval, 1.4-280.6; p = 0.02). These data suggest that uterine arteries being obscured to arterial infusion may be associated with a poor response to BOAI for cervical adenocarcinoma.