Interestingly, we also found that patients treated with selective/superselective TACE needed to undergo repeat procedures less frequently. In fact, we repeated TACE only in cases with persistent vital tumors; selective TACE led to a higher

rate of complete necrosis and thus limited the need for additional sessions in comparison with whole liver TACE. This might be beneficial in preventing progressive liver and vascular damage. However, we should acknowledge that the present study is not a prospective, randomized study comparing different treatment modalities, and lobar procedures were performed when selective/superselective ones could not be technically carried out for a variety of reasons (but mainly because of the vascular anatomy). It is, therefore, Cabozantinib research buy impossible to state with certainty that the results would still have differed if lobar TACE had been performed in patients undergoing selective/superselective TACE, who probably had a more favorable vascular anatomy. Nonetheless, according to the data available in the literature7 and the current study, we recommend pursuing all technical efforts and attempts to carry out selective/superselective TACE. This statement may appear obvious. However, selective/superselective TACE is usually more time-consuming, more expensive

in terms of angiography room occupancy and disposable materials, and more technically demanding than AZD6738 price conventional TACE; thus, inexperienced or overloaded operators may be tempted to routinely carry out lobar TACE, which should instead be avoided. We also found that the treatment of single nodules significantly affected tumor necrosis: single nodules showed a higher degree ifoxetine of mean tumor necrosis (86.1%) than multiple nodules (57.1%, P = 0.001). Patients with a single nodule who were treated with selective/superselective or lobar TACE tended to have a higher percentage of necrosis in comparison with patients with multiple

nodules who were treated with lobar TACE (P = 0.172). Another interesting finding is the relationship observed between tumor necrosis and the diameter of the nodule. We noted a significantly direct relationship between necrosis and the tumor diameter: the greater the tumor diameter, the greater the percentage of necrosis. To correctly interpret these data, we should consider that our patient population had small HCC nodules (all < 5 cm and almost all < 4 cm). Thus, 21 of the 122 nodules of the complete series (mainly nodules 3-4 cm in size) showed the best response. It is well known that larger HCCs are fed by larger arteries; this leads to better visualization of the nodule during angiographic examination.