85.6%, P=0.304) survival rates, suggesting that RFA is an acceptable alternative treatment in patients with solitary CRHM smaller than 3 cm who are not candidates for resection. In another study, Otto et al. (63) showed that there is no difference in overall 3-year survival between resection and RFA for early CRHM, even though RFA was associated with higher local tumor recurrence rates and shorter time to progression. In yet another recent study, Kim et al. (52)

suggest that RFA may be a safe alternative treatment for solitary CRHM <3 cm, with equivalent outcomes Inhibitors,research,lifescience,medical (overall and disease-free survival) compared to resection. These data suggest that RFA represents an effective local treatment for patients who are unsuitable for conventional surgical treatment. However, caution is warranted in using CI-1033 datasheet ablation Inhibitors,research,lifescience,medical in lieu of resection for patients who are suitable candidates for surgical treatment. Ablation should NOT be seen as a replacement for hepatic resection and does not preclude the need of systemic chemotherapy. Furthermore, the candidates for this specific approach are likely to be few. Important clinical and technical considerations for thermal tumor ablation

Just as the vast majority of patients with CRHM are not candidates for potentially curative resection, most will also Inhibitors,research,lifescience,medical not be candidates for evolving strategies that includes staged hepatic resection with or without tumor ablation, regional infusion therapies, and the preceding approaches in the context of systemic regimens. The evolving field of regional hepatic therapies lacks mature data to guide the Inhibitors,research,lifescience,medical approach, such as the

optimal sequence of therapies and defining the target patient population that may be most likely to benefit. As such, we put forth a few caveats, which are critical in the treatment planning process for these complex patients. The most important determinant of outcome for patients with CRHM is the biology or extent of disease. Regardless of the treatment efficacy of any one modality at the local level (liver), the presence of progressive, persistent, or chemotherapy-refractory systemic disease should in most instances preclude the use of resection or thermal Inhibitors,research,lifescience,medical tumor ablation. heptaminol Assuming the conditions described in the previous paragraph are met, the limitations of thermal tumor ablation are straightforward, and by no means complete in the listing that follows: (I) At any given time, there must be sufficient hepatic reserve to ensure adequate function. (II) The use of ablation as a prelude to resection should encompass the principles of known treatment failures, such as heat sinks. Basing a future liver remnant on a portion of liver at high risk for persistent or recurrent tumor in the ablation zone should be avoided. (III) The potential for inadvertent for injury to vital hepatic structures needs to be carefully considered utilizing TTA for CRHM, particularly in the context of a staged approach to ensure adequate inflow and outflow for the liver remnant.