Radiofrequency energy was delivered with a 17-G, Cool-Tip electrode with a 2-cm (nodules ≤ 1.5 cm in diameter) or 3-cm (nodules 1.5–2.5 cm) exposed metallic tip (Radionics) introduced into the center of the nodule. For nodules greater than 2.5 cm, multiple needle MK-8669 punctures were performed with a 3-cm exposed metallic tip. In the 70 (80%) of 88 patients with hypervascular HCC nodules confirmed on CT during hepatic arteriography, TACE was performed an average 3 days before RFA. TACE was performed through the femoral artery using the technique of Seldinger under local anesthesia.

An angiographic catheter was inserted selectively into the hepatic feeding artery of a segment or subsegments containing the target tumor. We used cisplatinum (Randa; Nippon Kayaku, Tokyo, Japan) as an anticancer drug mixed with iodized oil (Lipiodol; Nihon Schering, Tokyo, Japan) at a concentration of 10 mg/mL and injected at a dose of 10–40 mg/body. The Torin 1 cost selected dose was based on tumor size. Injection was discontinued upon full accumulation of iodized oil in the tumor vessels. No gelatin sponge or coil embolization was used after TACE in the present study. To evaluate the efficacy of RFA, dynamic CT was performed at 2–3 days after each treatment session using the protocol described for pretreatment imaging studies. CT findings were confirmed by consensus between the two radiologists. On dynamic CT images, the non-enhancing

area was measured as the ablated area. When the diameter of the non-enhancing area was greater than that of the ablated nodule, RFA was considered to have produced a complete effect and the treatment was terminated. When the diameter of the necrotic area was closely similar to that of the tumor without any ablated margin or when the only partial enhancement of a portion of the tumor was seen, RFA was considered to have produced an incomplete effect, and an additional session of ablation was accordingly performed 3–5 days

later, and in principle repeated until a complete effect was confirmed. The outcome of RFA was evaluated in CT images taken 3–4 weeks after the final RFA session. Follow-up US and dynamic CT were performed at 3- to 4-month intervals using protocols similar to those applied Resveratrol in the pretreatment studies. Serum HCC-specific tumor markers, including α-fetoprotein (AFP), its lectin fraction 3, and des-γ-carboxy prothrombin (DCP), were measured every 1–2 months. Local tumor progression was determined when a subsequent follow-up CT demonstrated any tumor growth or enhancement in the ablation zone, where complete primary effectiveness (i.e. no evidence of residual tumor) was previously obtained. Secondary effectiveness was evaluated in patients who underwent follow-up CT 1 year or more after RFA,19 and included tumors that underwent successful repeat RFA after the identification of local tumor progression.