749 Survival of patients with liver metastases of colorectal origin treated with percutaneous ethanol injection (PEI) with or without surgery

Abstract

The purpose of the present study is to evaluate, after four years of observation, the influence of PEI upon the survival (S) of pts with liver metastases from colorectal carcinoma. Between April 91 and December 94, 31 lesions (7 synchronous, 26 metachronous) with a mean diameter of 2.99cm (0.8–6.1) in 24 pts (41, 20 M, mean age 62.4 years, range 49–77) were treated with PEI. Using an ultrasound scanner (AU-590 Esaote-Biomedica), fine needles (Spinal-Icogamma, Ethanoject-TSK 22G), following the usual technique of alcoholization, varying amount of sterile alcohol (0.5–10ccs) at 95° were introduced into the lesions, for the total of 804 alcoholizations. The response was evaluated by means of fine needle echo-guided biopsy (FNAB) carried out at the end of treatment: CR=necrobiosis and absence of CTM; PR=necrobiosis and rare, poorly-conserved, atypical CTM. After the starting of PEI treatment (mean 4–9 months), 10 pts underwent surgery with exeresis ofa total of 15 lesions. 21/24 pts responded to the treatment; of 33 treated lesions, we observed 6 CR (18.1%), 22 PR (66.6%), 3 NC and 2 local PRO. Histological confirmation of the cytologic response was obtained in 14/15 lesions undergone surgical exeresis. 10/24 pts died after a mean S of 13.5 months, in 9 cases due to extrahepatic disease progression. Follow-up of the 14 alive pts is 17.5 months than S in 10 operated pts is 20.6 months, in 14 unoperated pts is 12.5 months. Overall survival is 15.8 months. The comparison between our results and S reported in literature (6–12 months) comprehending any degree of hepatic involvement, is not possible since the criteria of admission are not homogeneous. From a retrospective evaluation of 30 dead pts, followed in our service between ‘84 and ‘90 with liver metastases eligible for PEI but treated only with conventional CT, we observed a mean of S of 13.2 months; the mean follow up of our PEI-treated pts (17.5) has already surmounted that value, thus confirming the real efficacy of PEI. The good result of mean follow-up is undoubtedly supported by the presence of pts undergone surgical exeresis. For this reason we calculated separately the mean S of unoperated pts, getting a result (13.2 months) next to the mean S of the survey group and expected to improve, since it regards still living pts. In conclusion, we observed a real efficacy of PEI upon liver metastases, followed when possible by surgical exeresis; anyway PEI is a valid choice also in unoperable pts as palliative treatment in local control of disease.