Bartolozzi et al. performed an RCT of TACE plus PEIT combination therapy versus TACE alone in patients with hepatocellular carcinoma measuring 3.1–8 cm in diameter, and reported that there was no significant difference in the survival rate, but the recurrence-free survival was better with the combination therapy. In addition, hepatic functional reserve worsened 1 year later in the TACE group after repeating the treatment for two

to five courses (LF016352 level 1b). Becker et al. carried out an RCT SB431542 cell line of TACE alone and TACE plus PEIT in 52 hepatocellular carcinoma patients (tumors ≥5 cm in diameter, n = 34; four or more lesions, n = 11) and reported that there was no difference in prognosis for the entire patient population, but the prognosis was better in the TACE plus PEIT group in an analysis of just the 26 Okuda stage I patients

(hazard ratio = 0.4; P = 0.04) (LF110553 level 1b). We examined whether the addition of local therapy after TACE in patients with tumors larger than 3 cm in diameter or multiple tumors, which are usually not indicated for local therapy but instead for TACE, would contribute to the improvement of prognosis. There were only reports on RCT with a small sample size or non-RCT, but all of the results showed that the prognosis was better for this website TACE plus PEIT. However, many issues remain unknown, for example, among tumors larger than 3 cm or four or more lesions, prolongation of survival can be obtained up to what diameter of the tumors and up to how many lesions. Also, the addition of local ablation therapy may worsen the prognosis in patients with poor liver function. Thus, the indications should be carefully considered. In terms of whether TACE

in combination with RFA improves prognosis, adequate evidence is lacking at present. CQ51 Does RFA with the interruption of blood flow improve prognosis? The range of necrosis increases when RFA is performed with blood flow interruption, but whether this improves the prognosis needs to be investigated in the future. (grade C1) Yamasaki et al. compared RFA (four patients, five nodules) with hepatic arterial balloon occlusion and routine RFA (six patients, seven nodules) in 上海皓元 patients with hepatocellular carcinoma measuring less than 4 cm in diameter and noted an increase in the volume of necrosis (major axis 38.2 ± 2.8 vs 30.0 ± 4.1 mm, P = 0.009, minor axis 35.0 ± 1.7 vs 27.0 ± 4.3 mm, P = 0.006). No serious complications occurred (LF000341 level 2a). Kobayashi et al. conducted an RCT of RFA alone and RFA with hepatic arterial balloon occlusion in 30 patients with a single hepatocellular carcinoma measuring 3 cm or less and reported that the minor axis of the ablation area was significantly larger for the RFA plus hepatic arterial balloon occlusion group than for the RFA alone group at 36 mm vs 26 mm (LF108552 level 1b).