Percutaneous Ethanol Injection Injectables in the Treatment of Primary Liver Cancers
Percutaneous local ablation therapy is the best treatment option for patients with early-stage hepatocellular carcinoma (HCC) who are not suitable for resection or transplantation. Percutaneous ethanol injection (PEI) is the first mainstream modality of ablation and used to be a standard alternative therapy for unresectable small HCCs since the 1980s. To achieve complete devitalization of the tumor, conventional PEI using a fine needle usually needs multiple treatment sessions dependent on the tumor size, typically 4–12 sessions at twice-weekly interval. Conventional PEI offers satisfactory local efficacy and long-term survival in treating tumors smaller than 3 cm, but unsatisfactory complete response of tumors larger than 3 cm, mainly because of the influence of intratumoral septa. There have been major efforts to develop new methods for solving this problem. Single-session high-dose PEI using a single needle, simultaneous multiple needles, and a multi-pronged needle was subsequently applied. The latest multi-pronged PEI injection devices achieve better local efficacy than conventional PEI and are able to treat early-stage or recurrent HCC up to 5 cm effectively and safely, even for lesions at high-risk locations. Combined use of PEI with radio-frequency ablation may potentially improve the local efficacy of both techniques. Compared with radio-frequency ablation, PEI has the advantages of minor side effects, simplicity, and low cost. Local efficacy of PEI has been improved by innovative technique. Therefore, PEI will continue to play a role in the treatment of HCC.
KeywordsComplete Response Rate Percutaneous Ethanol Injection Radio Frequency Ablation Major Complication Rate Local Efficacy
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