In comparison with lobar TACE, selective/superselective TACE led to significantly higher mean levels of necrosis (75.1% versus this website 52.8%, P = 0.002) and a higher rate of complete necrosis (53.8% versus 29.8%, P = 0.013). A significant direct relationship was observed between the tumor diameter and the mean tumor necrosis level (59.6% for lesions < 2 cm, 68.4% for lesions of 2.1-3 cm, and 76.2% for lesions > 3 cm). Histological necrosis was maximal for tumors > 3 cm: 91.8% after selective/superselective TACE and 66.5% after lobar procedures. Independent predictors

of complete tumor necrosis were selective/superselective TACE (P = 0.049) and the treatment of single nodules (P = 0.008). Repeat sessions were more frequently needed for nodules treated with lobar TACE (31.6% versus 59.3%, P = 0.049). Conclusion: Selective/superselective TACE was more successful than lobar procedures in achieving complete histological necrosis, and TACE was more effective in 3- to 5-cm tumors than in smaller ones. (Hepatology 2011;) Transarterial chemoembolization (TACE) is the recommended treatment strategy for patients with intermediate-stage hepatocellular carcinoma (HCC) according to the American Association for the Study of Liver Diseases guidelines.1, 2 In the setting of liver transplantation (LT), TACE is applied both to reduce the dropout rate for patients on the waiting list (bridge therapy) and to downstage patients with HCC not initially meeting

the transplantability criteria DMXAA nmr (downstaging protocols).3 The capability of TACE to induce extensive tumor necrosis is still under debate, and this technique is considered to be a noncurative modality. Staurosporine price Whether this belief derives from the real potential

of the technique or from the fact that it has mainly been applied to tumors that are large and are, consequently, more difficult to treat is still a matter of discussion. Similarly, the role of the various technical modalities of TACE procedures in determining the final rate of necrosis has not been adequately investigated in Western countries. The recommendation for TACE as the standard of care for intermediate-stage HCC is based on the demonstration of improved survival in comparison with the best supportive care or suboptimal therapies in a meta-analysis of six randomized control trials.4 However, there was considerable heterogeneity between the individual study designs of the six trials, and the differences included the patient populations and TACE techniques. More specifically, the oldest trials of the meta-analysis included lobar or whole liver embolization (i.e., the injection of a mixture of Lipiodol, a chemotherapeutic agent, and an embolizing material into either the main lobar artery or the hepatic artery itself), whereas more recently, selective treatments have been used (i.e., the injection of agents into the segmental or subsegmental branches feeding the tumors) with apparently better survival results.