On the day of treatment the laboratory data, including a complete blood cell count, complete metabolic panel, and prothrombin time, were obtained. Standard preprocedural medications included ondansetron hydrochloride (8 mg), dexamethasone sodium phosphate (10 mg), and metronidazole hydrochloride (500 mg). Local anesthesia was obtained with buffered lidocaine hydrochloride, 1%, and sedation was achieved with intravenous midazolam hydrochloride and fentanyl citrate. After sterile preparation and draping, the common femoral artery was accessed with the use of the Seldinger technique. Superior mesenteric angiography was performed through the portal venous phase to evaluate for portal vein patency and flow direction and to detect variant arterial anatomic features. Celiac artery angiography was followed by selection of the right or left hepatic artery with a microcatheter. After confirmation of the appropriate position, HACE was performed with a mixture of cisplatin (50 mg), doxorubicin hydrochloride (50 mg), and mitomycin (10 mg) dissolved in sterile contrast material (ioversol [Optiray 350]; Mallinckrodt Medical, St Louis) and emulsified with ethiodized oil (Ethiodol, Savage Laboratories, Melville, New York). After infusion of the chemotherapeutic agents under fluoroscopic monitoring, embolization was performed with absorbable gelatin sponge slurry (Gelfoam; Pharmacia & Upjohn, Kalamazoo, Michigan) or 300- to 500-mm polyvinyl alcohol particles mixed in contrast material. Embolization was continued until near-stasis of flow was achieved in the tumor-feeding branches. The decision to use polyvinyl alcohol particles was made by the primary operator (J.E.G. or D.B.B.) at the time of the procedure and was reserved for cases in which feeding arteries were severely pruned owing to prior treatment. The use of the particles did not limit further HACE. One- to 3-mL aliquots of lidocaine hydrochloride, 1%, were intermittently administered intra-arterially during infusion of the chemotherapeutic mixture. Up to 1 lobe was treated per HACE session. If necessary, the contralateral hepatic lobe was treated 4 to 6 weeks after the initial procedure.