Figure 1 Schematic drawing of PAA using three small ablation foci at the area where the feeding artery entered the tumor, to block the blood supply of HCC. Patients selleck products in group B underwent routine RFA treatment using multiple overlapping ablation spheres to cover the tumor and the safe margin beyond the tumor of 0.5-1 cm[13]. During RFA, moderate intravenous sedation was induced with 2.5-5.0 mg midazolam (Roche, Basel, Switzerland) and 50-100 ��g fentanyl (Fentaini; Renfu, Yichang, China). Local infiltration anesthesia was induced by 5-15 mL 1% lidocaine (Liduokayin; Yimin, Beijing, China). If patients with tumors adjacent to the diaphragm and hepatic hilum experienced local and right shoulder pain when the ablation was extended, intravenous infusion of propofol (Diprivan, 1-2 mg/kg; Zeneca, Macclesfield, UK) was given for temporary anesthesia enhancement.

The patients were conscious when the RFA electrode was placed, and vital signs and oxygen saturation were monitored continuously during the procedure. After RFA, the patients underwent close medical observation and were rescanned within 1-2 h after the procedure to detect any bleeding in the liver or the peritoneal cavity. All patients stayed in the hospital overnight. Any adverse events were evaluated and recorded. Major complications were defined as those that, if left untreated, might have threatened the patient��s life, led to substantial morbidity and disability, or resulted in hospital admission or a substantially lengthened hospital stay. All other complications were considered minor.

Assessment of therapeutic efficacy Treatment response was assessed by contrast-enhanced spiral CT at 1 mo after RFA and complete response was considered to be achieved if the CT scans revealed: (1) the ablation zone was beyond the original tumor borders; (2) the margin of the ablation zone was clear and smooth; and (3) no arterial enhancement or abnormal wash-out was detected within or around the tumor. Subsequently, the patients were followed-up with serum alpha-fetoprotein (AFP) measurement, abdominal US, and contrast-enhanced CT every 2-3 mo in the first year, and then every 4-6 mo thereafter. All patients were followed-up for at least 6 mo. Recurrence was defined as enhancement within or at the periphery of the ablated area in the follow-up CT scan. Recurrent HCC was treated with another session of RFA.

All CT scans were Anacetrapib reviewed by two radiologists with more > 10 years experience, who were unaware of patient clinical data or treatment assignment. Statistical analysis Differences in complete necrosis rate at 1 mo and recurrence rate at 6 mo were analyzed by ��2 and t tests where appropriate. The recurrence rate was determined by log-rank tests, and multivariate hazard ratio was calculated using the Cox proportional hazard model. The Kaplan-Meier estimate of the cumulative recurrence rates over time was also carried out. All P values were two-sided, and P �� 0.