5 mg/m2/dose D3), followed by a reassessment to determine tumor response. If a partial response was achieved, TACE combined with HIFU was then performed. If unsatisfactory, two more C5VD regimens were subsequently administered for these patients (cisplatin: 100 mg/m2/dose D1; 5-fluorouracil: 600 mg/m2/dose D3; vincristine: 1.5 mg/m2/dose D3; doxorubicin: 10-15 mg/m2/dose D4). No patient needed to be omitted from the study due to the toxicity of doxorubicin. After the patients finished the initial chemotherapy cycles, they underwent CT/MRI examination again. A reassessment was subsequently performed by the Pediatric Oncology team to evaluate the tumor response. It was obvious that

the tumor blood supply was significantly reduced after chemotherapy, and the

margin between ICG-001 the tumor and normal liver was much clearer. The tumor size also decreased after chemotherapy in all patients. Based on the follow-up radiological findings, 6 of 12 patients would be able to undergo a partial hepatectomy after chemotherapy due to the decreased tumor size. However, their parents all refused the surgical procedure, although our team discussed with them Dasatinib in vitro several times how important the hepatectomy is in terms of a cure method for hepatoblastoma. They hoped to continue the trial protocol due to the noninvasive nature of HIFU treatment. After TACE combined with HIFU treatments, all patients received at least four cycles of adjuvant chemotherapy with C5V regimen. The AFP levels decreased steadily

except in one patient with a tumor embolus in the portal vein (patient no. 12). All patients received TACE before HIFU ablation. TACE was performed by two interventional radiologists with the use of the Seldinger technique of arterial embolization described previously.[8] Under general anesthesia, the femoral artery is cannulated using the Seldinger technique and a 4- or 5-F sheath with a hemostatic valve is placed in the groin. Then hepatic arteriography was performed to demonstrate the hepatic arterial branching and size and location of tumor. Dichloromethane dehalogenase According to the size, location, and arterial blood supply of the tumors, either the right or left hepatic artery was catheterized selectively guided by digital subtraction angiography. A 3- to 5-F tracker catheter was catheterized to the feeding arteries of tumors for superselective embolization. The feeding arteries of all tumors were embolized with the use of the suspension mixed with either 100 mg/m2 of Carboplatin (Qilu Pharmaceutical Factory, Jinan, China) or 10-15 mg/m2 of adriamycin (Pfizer, Nerviano, Italy) and 3-8 mL of iodized oil (Lipiodol; Huaihai Pharmaceutical Factory, Shanghai, China). After initial chemotherapy, the tumor size was significantly decreased in all patients. However, there were six patients with lesions in both lobes of the liver.