Abstract
Percutaneous ethanol injection (PEI) is performed under ultrasound guidance, with multiple sessions in the out-patient department or with the “single-session” technique under general anesthesia, according to the size and number of the lesions. In our patients, with Child A (293), B (149), or C (20) cirrhosis and single hepatocellular carcinoma (HCC) lesions of 5 cm or smaller, the 1-, 3-, and 5-year survival rates were 98%, 79%, and 47%, 93%, 63%, and 29%, and 64%, 12%, and 0%, respectively. In our 108 patients with larger HCC, 1-, and 3-year survival rates were 72% and 57% in single, encapsulated tumors, 73% and 42% in single infiltrating or multiple encapsulated tumors, and 46% and 0% in symptomatic or with advanced portal thrombosis tumors. PEI proved to be a safe, effective, repeatable, easy, and low-cost therapy for HCC. Survival after PEI was comparable to that after surgical resection, probably because of the balance between the greater complete ablation rate of surgery compared to the absence of early mortality and liver damage using PEI. On the basis of the PEI rationale, other ablation techniques were proposed using radio frequency, laser, or acetic acid methods, and their initial results are promising.
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References
Livraghi T, Festi D, Monti F, Salmi A, Vettori C (1986) US-guided percutaneous alcohol injection of small hepatic and abdominal tumors. Radiology 161:309–312
Ohnishi K, Ohyama M, Ito S, Fujiara K (1994) Ultrasound guided intratumor injection of acetic acid for the treatment of small hepatocellular carcinoma. Radiology 193: 747–752
Masters A, Steger AC, Lees WR (1992) Interstitial laser hyperthermia: a new approach for treating liver metastases. Br J Cancer 66:518–522
Rossi S, Fornari F, Buscarini L (1993) Percutaneous ultrasound guided radiofrequency electrocautery for the treatment of small hepatocellular carcinoma. J Intervent Radiol 8:97–103
Murakami R, Yoshimatsu S, Yamashita Y, Matsukawa T, Takahashi M, Sagara K (1995) Treatment of hepatocellular carcinoma: value of percutaneous microwave coagulation. AJR 164:1159–1164
Livraghi T, Giorgio A, Marin G, Salmi A, de Sio I, Bolondi L, Pompili M, Brunello F, Lazzaroni S, Torzilli G, Zucchi A (1995) Hepatocellular carcinoma and cirrhosis in 746_patients: long-term results of percutaneous ethanol injection. Radiology 197: 101–108
Livraghi T, Vettori C, Torzilli G, Lazzaroni S, Pellicanò S, Ravasi S (1993) Percutaneous ethanol injection of hepatic tumors: single session therapy under general anesthesia. AJR 160:1065–1069
Livraghi T, Grigioni W, Mazziotti A, Sangalli G, Vettori C (1990) Percutaneous ethanol injection of portal thrombosis in hepatocellular carcinoma: a new possible treatment. Tumori 76:394–397
Shimada M, Takenaka K, Fujiwara Y, Gion T, Kajiyama K, Maeda T, Shirabe K, Sugimachi K (1996) Des-gamma-carboxy prothrombin and AFP positive status as a new prognostic indicator after hepatic resection for hepatocellular carcinoma. Cancer (Phila) 78:2094–2100
Di Stasi M, Buscarini T, Livraghi T, Giorgio A, Salmi A, De Sio I, Brunello F, Solmi L, Caturelli E, Magnolfi F, Caremani M, Filice C (1997) Percutaneous ethanol injection in the treatment of hepatocellular carcinoma. Scand J Gastroenterol 32:1168–1173
Taavitsainen M, Vehmas T, Kauppila R (1993) Fatal liver necrosis following percutaneous ethanol injection for hepatocellular carcinoma. Abdom Imaging 18:357–359
Livraghi T, Benedini V, Lazzaroni S, Meloni F, Torzilli G, Vettori C (1998) Long-term results of single session PEI in patients with large hepatocellular carcinoma. Cancer (Phila) 83:48–57
Ebara M, Otho M, Sugiura N, Okuda K, Kondo F, Kondo K (1990) Percutaneous ethanol injection for the treatment of small hepatocellular carcinoma: study of 95 patients. J Gastroenterol Hepatol 5:616–626
Shiina S, Tagawa K, Niwa Y, Unuma T, Komatsu Y, Yoshiura K, Hamada E, Takahasi M, Shiratori Y, Terano A, Omata M, Kawauchi N, Inoue H (1993) Percutaneous ethanol injection therapy for hepatocellular carcinoma: results in 146 patients. AJR 160: 1023–1028
Tanikawa K (1992) Multidisciplinary treatment of hepatocellular carcinoma. In: Tobe T, Kameda H (eds) Primary liver cancer in Japan. Springer-Verlag, Tokyo, pp 327–334
Oka H, Kurioka N, Kim K, Kanno T, Kuroki T, Mizoguchi Y, Kobayashi K (1990) Prospective study of early detection of hepatocellular carcinoma in patients with cirrhosis. Hepatology 12:680–687
Shiina S, Tagawa K, Unuma T, Takanashi R, Yoshiura K, Komatsu Y, Hata Y, Niwa Y, Shiratori Y, Terano A, Sugimoto T (1991) Percutaneous ethanol injection therapy for hepatocellular carcinoma: a histopathologic study. Cancer (Phila) 68:1524–1530
Yamashita Y, Torashima M, Ognuni T, Yamamoto A, Harada M, Miyazaki T, Takahashi M (1993) Liver parenchymal changes after transcatheter arterial embolization therapy for hepatoma. CT evaluation. Abdom Imaging 18:352–356
Groupe d’Etude et de Traitement du Carcinome Hepatocellulaire (1995) A comparison of lipiodol chemoembolization and conservative treatment for unresectable hepatocellular carcinoma. N Engl J Med 332:1256–1261
Livraghi T, Bolondi L, Buscarini L, Cottone M, Mazziotti A, Morabito A, Torzilli G (1995) No treatment, resection and ethanol injection in hepatocellular carcinoma: a retrospective analysis of survival in 391 cirrhotic patients. J Hepatol 22:522–526
Sheu JC, Huang GT, Chou HC (1993) Multiple hepatocellular carcinomas at the early stage have different clonality. Gastroenterology 105:1471–1476
Okuda K (1993) Intratumor ethanol injection. J Surg Oncol 3(suppl):97–99
Kotoh K, Sakai H, Sakamoto S, Nakayama S, Satoh M, Morotomi I, Nawata H (1994) The effect of percutaneous ethanol injection therapy on small solitary hepatocellular carcinoma is comparable to that of hepatectomy. Am J Gastroenterol 89:194–198
Orlando A, Cottone M, Virdone R, Parisi P, Maringhini A, Caltagirone M, Simonetti R, Pagliaro L (1997) Treatment of small hepatocellular carcinoma associated with cirrhosis by percutaneous ethanol injection. Scand J Gastroenterol 32:598–603
Ryu M, Shimamura Y, Kinoshita T, Konishi M, Kawano N, Iwasaki M, Furuse J, Yoshino M, Moriyama N, Sugita M (1997) Therapeutic results of resection, TAE and PEI in 3 225_patients with hepatocellular carcinoma: a retrospective multicenter study. Jpn J Clin Oncol 27:251–257
The Liver Cancer Study Group of Japan (1994) Predictive factors for long-term prognosis after partial hepatectomy for patients with hepatocellular carcinoma. Cancer (Phila) 74:2772–2780
Takayama T, Makuuchi M (1997) Surgical resection. In: Livraghi T, Makuuchi M, Buscarini L (eds) Diagnosis and treatment of hepatocellular carcinoma. Greenwich Medical Media, London, pp 279–286
Goldberg SN, Gazelle GS, Dawson SL, Mueller PR, Rittman W, Rosenthal DI (1995) Radiofrequency tissue ablation using multiprobe arrays: greater tissue destruction than multiple probes operating alone. Acad Radiol 2:670–674
Livraghi T, Goldberg SN, Monti F (1997) Saline-enhanced radiofrequency tissue ablation in the treatment of liver metastases. Radiology 202:205–210
Rossi S, Buscarini E, Garbagnati F (1988) Percutaneous treatment of small hepatic tumors by an expandable RF needle electrode. AJR 170:1015–1022
Goldberg SN, Gazelle GS, Solbiati L, Rittman WJ, Mueller PR (1996) Radiofrequency tissue ablation: increased lesion diameter with a perfusion electrode. Acad Radiol 3:636–644
Solbiati L, Goldberg SN, Ierace T, Livraghi T, Mueller PR, Gazelle GS (1997) Radiofrequency ablation of hepatic metastases with cooled-tip electrodes: results in 33 patients. Radiology 205:367–373
Livraghi T, Goldberg SN, Lazzaroni S, Meloni F, Solbiati L, Gazelle GS (1999) Radiofrequency ablation vs. ethanol injection in the treatment of small hepatocellular carcinoma. Radiology 210:655–661
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Livraghi, T. (2000). Percutaneous Ablation of Hepatocellular Carcinoma. In: Okita, K. (eds) Progress in Hepatocellular Carcinoma Treatment. Springer, Tokyo. https://doi.org/10.1007/978-4-431-67913-4_4
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DOI: https://doi.org/10.1007/978-4-431-67913-4_4
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