Research frontiers For hypervascular HCC, RFA appears less effective because of the blood-flow-induced heat sink effect, which might cause incomplete ablation or recurrence. Previous experiments have shown that mechanical and pharmacological strategies that are aimed order inhibitor at lowering hepatic perfusion can increase the size of thermally induced lesions. Innovations and breakthroughs Repeated transcatheter arterial chemoembolization (TACE) worsened liver function and quality of life, and then prolonged the interval between TACE and RFA. In order to overcome these disadvantages, the study used PAA to ablate the area where the feeding artery entered the tumor, with small overlapping, high-energy ablating foci. This procedure was conducted through one puncture point using three ablations in different directions or depths.

After PAA, the tumor��s feeding artery was blocked, thus reducing the blood-flow-induced heat loss, and achieving a similar result as that with TACE before RFA. PAA avoided damage to the surrounding liver parenchyma and liver function compared with TACE, and was well-tolerated by patients. Applications The study results suggested that, for hypervascular HCC patients who were unsuitable for surgical resection or TACE, PAA was an alternative for effectively blocking the feeding artery of the tumor, and reducing heat loss during subsequent RFA. The combination of PAA and RFA may significantly decrease post-RFA recurrence and provide a safe and effective treatment for hypervascular HCC.

Terminology PAA: Color Doppler flow imaging was used to identify the major feeding artery and guide the RFA needle to puncture the area where the feeding artery entered the tumor. This area was ablated with 2-3 overlapping high-energy ablation foci (2-3 cm each in diameter) in different directions or depths. Peer review This is a good original study in which authors performed a new approach to block the major feeding artery and reduce heat loss during subsequent RFA. The results are interesting and suggest that the combination of PAA and RFA significantly decreases post-RFA recurrence and provides a safe and effective treatment for hypervascular HCC. Acknowledgments We Batimastat thank Dr. Dai Y for the manuscript review and Dr. Feng GS for data analysis and comments. Supported by A special Incubation Fund of major research plan of BMSTC, Z0005190040431, and the National High Technology Research and Development Program of China, 863 Program, No. 2007AA02Z4B8 Peer reviewers: Dr.