Abstract
For the purpose of achieving emergency hemostasis of a ruptured hepatocellular carcinoma (HCC) or prevention of such rupture, we applied a new method of transcatheter therapy: intra-arterial alcoholization. Five patients with a ruptured HCC and 42 with an impending rupture were treated by intra-arterial injection of absolute ethanol mixed with an equal volume of iodized oil, Lipiodol (EtOH-Lp). The tumor size ranged from 4 to 26 cm (mean 7.8 cm) in diameter. The catheter tip was placed in the segmental branch or a more distal position of the hepatic artery, and 2–40 (mean 10.6) ml of EtOH-Lp was infused under fluoroscopic guidance. Infiltration of ethanol into the HCC mass was recognized as a dense deposition of Lipiodol on plain abdominal X-rays and computed-tomography. In all five cases of ruptured HCC, hemostasis was achieved. In all 42 cases of impending rupture, tumor rupture was prevented, and all except 3 patients could be discharged. No significant complication of the gastrointestinal tract or biliary tract was seen. The incidence and severity of postembolization syndrome were markedly lower than those seen in cases treated with Gelfoam embolization.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Berhold F, Shultheis KH, Aigner K, Lampert F (1986) Kombinationschemotherapie und Chemoembolisation bei der Behandlung primaer inoperabler Hepatoblastome. Klin Paediatr 198: 257
Chearanai O, Plengnavit U, Asavanich C, Damrongsac D, Sindhvananda K, Boonyapisit S (1983) Spontaneous rupture of primary hepatoma. Report of 63 cases with particular reference to the pathogenesis and rationale treatment by hepatic artery ligation. Cancer 51:1532
Doppman JL, Girton ME (1984) Bile duct scarring following ethanol embolization of the hepatic artery: an experimental study in monkeys. Radiology 152:621
Ebara M, Ohto M, Sugiura N, Kita K, Yoshikawa M, Okuda K, Kondo F, Kondo Y (1990) Percutaneous ethanol injection for the treatment of small hepatocellular carcinoma. Study of 95 patients. J Gastrohepatol 5:616
Ellman BA, Parkhill BJ, Curry TS III, Marcus PB, Peters PC (1981) Ablation of renal tumors with absolute ethanol: a new technique. Radiology 141:619
Hirai K, Kawazoe Y, Yamashita K, Kumagai M, Nagata K, Kawaguchi S, Abe M, Tanikawa K (1986) Transcatheter arterial embolization for spontaneous rupture of hepatocellular carcinoma. Am J Gastroenterol 81:275
Jaschke W, Hoevels J (1988) Control of hepatic tumor hemorrhage by transcatheter embolization with Ethibloc. Acta Radiol (Oncol] 29:15
Kauffman GK, Rohrbach R, Richter G, Rassweiler J, Sommerkamp H (1984) Nierentumorembolisation — Fortschritte, Erfahrungen und Komplikationen. Urologe [A] 23:109
Liver Cancer Study Group of Japan (1990) Primary liver cancer in Japan: clinicopathologic features and results of surgical treatment. Ann Surg 211:277
Matsui O, Kawamura I, Kadoya M, Takashima T, Nakanuma Y (1986) Hepatic artery embolization of experimental hepatic tumors with absolute ethanol. Cardiovasc Intervent Radiol 9:146
Matsui O, Kadoya M, Yoshikawa J, Gabata T, Arakawa K, Kobayashi A, Demachi H, Takashima T (1990) Ultraselective segmental embolization for hepatocellular carcinoma using the mixture of absolute ethanol and Lipiodol (in Japanese). Acta Hepatol Jpn 31:108
Matsui O, Kadoya M, Yoshikawa J, Gabata T, Arai K, Demachi H, Miyayama S, Takashima T, Unoura M, Kobayashi K (1993) Subsegmental TAE for small hepatocellular carcinomas. Radiology (in press)
Mokka R, Seppala A, Huttunen R, Kairaluoma M, Sutinen S, Larmi TKI (1976) Spontaneous rupture of liver tumours. Br J Surg 63:715
Nagasue N, Inokuchi K (1979) Spontaneous and traumatic rupture of hepatoma. Br J Surg 66:248
Ohishi H, Uchida H, Yoshimura H, Ohue S, Ueda J, Katsuragi M, Matsuo N, Hosogi Y (1985) Hepatocellular carcinoma detected by iodized oil: use of anticancer agents. Radiology 154:25
Okazaki M, Higashihara H, Kokanemaru F, Nakamura T, Kitsuki H, Hoashi T, Makuuchi M (1991) Intraperitoneal hemorrhage from hepatocellular carcinoma: emergency chemoembolization or embolization. Radiology 180:647
Okuda K (1976) Clinical aspects of hepatocellular carcinoma. Analysis of 134 cases. In: Okuda K, Peters RL (eds) Hepatocellular carcinoma. John Wiley & Sons, New York London Sydney Toronto, p 387
Okuda K, Ohtsuki T, Obata H, Tomimatsu M, Okazaki N, Hasegawa H, Nakajima Y, Ohnishi K (1985) Natural history of hepatocellular carcinoma and prognosis in relation to treatment. Study of 850 patients. Cancer 56:918
Ong GB, Chu EPH, Yo FYK, Lee TC (1965) Spontaneous rupture of hepatocellular carcinoma. Br J Surg 52:123
O'Riordan D, McAllister H, Sheahan BJ, MacErlean DP (1984) Hepatic infarction with absolute ethanol. Radiology 152:627
Park JH, Jeon SC, Kang HS, Im JG, Han MC, Kim CW (1986) Transcatheter renal arterial embolization with the mixture of ethanol and iodized oil (Lipiodol). Invest Radiol 21:577
Wallace S, Charnsangavej C, Carrasco CH, Bechtel W (1984) Ethanol for hepatic artery embolization. Radiology 152:821
Yamada R, Sato M, Kawabata M, Nakatsuka H, Nakamura K, takashima S (1983) Hepatic arterial embolization in 120 patients with unresectable hepatoma. Radiology 148:397
Yune HY, Klatte EC, Richmond BD, Rabe FE (1982) Absolute ethanol in thrombotherapy of bleeding esophageal varices. AJR 138:1137
Author information
Authors and Affiliations
Additional information
This study was supported by a grant from the Ministry of Health and Welfare of Japan
Rights and permissions
About this article
Cite this article
Ito, K., Kusunoki, H., Okamoto, E. et al. Intra-arterial alcoholization of advanced hepatocellular carcinoma. Cancer Chemother. Pharmacol. 33 (Suppl 1), S42–S47 (1994). https://doi.org/10.1007/BF00686667
Issue Date:
DOI: https://doi.org/10.1007/BF00686667