Abstract
BackgroundTo compare tumor necrosis in hepatoma induced in rats by a single percutaneous injection of ethanol (PEI) or acetic acid (PAI).MethodsBW7756 hepatomas of 1 mm3 were implanted in the liver of 40 male healthy rats. After 14 days, the 36 surviving rats were treated, in a single session, by ultrasound-guided injection of 300 μl of 95% ethanol (n = 17) or 100 μl of 50% acetic acid (n = 19). They were sacrificed 14 days after treatment and explanted tumoral livers were examined. The same PAI procedure was repeated on 13 additional rats to exclude a suspected occurrence of technical failures during the experiment, due to a surprisingly high rate of deaths within 30 minutes after PAI.ResultsFour rats died within four days after tumor implantation; after PEI, 1/17 (6%) died, whereas after PAI 9/19 (47%) died. The remaining 26 rats, after 14 days post-percutaneous ablation, were sacrificed. Gross and microscopic examinations showed that the hepatoma's nodules treated with PEI had 45.3 ± 19.4% tumor necrosis compared to 49 ± 23.3% (P = NS) for those treated with PAI. Complete tumor necrosis was not found in any animal. Peritoneal invasion was present in 4/16 (25%) and 2/10 (20%) rats treated with PEI or PAI, respectively (P = NS). Autopsy was performed in the 5 additional rats that died within 30 minutes after PAI.ConclusionOur results show that there is no significant difference in the percentage of tumor necrosis between two local ablation methods in spite of the different dosages used. However, mortality in the PAI-treated group was greater than in PEI-treated group, presumably due to greater acetic acid systemic diffusion and its metabolic side effects. In human subjects, HCC occurs in the setting of cirrhosis, where the non-tumoral tissue is firmer than the tumor structure, with consequent reduction of drug diffusion. This could be the reason why some human studies have concluded similar or even better safety and efficacy with PAI compared to PEI.
Highlights
To compare tumor necrosis in hepatoma induced in rats by a single percutaneous injection of ethanol (PEI) or acetic acid (PAI)
We evaluated in our study safety, efficacy and percentage of necrosis produced in a liver tumor with a single ultrasound-guided session of percutaneous ethanol injection (PEI) (300 μl 95%) in comparison to an equal single session of Percutaneous acetic acid injection (PAI) (100 μl 50%) in male rats with BW7756 hepatoma, sacrificed 14 days after the procedure
In our study on animals, we did not observe complete necrosis either with PEI or PAI treatment, because the single treatment session we performed on each animal would not be sufficient to cause it
Summary
To compare tumor necrosis in hepatoma induced in rats by a single percutaneous injection of ethanol (PEI) or acetic acid (PAI). Percutaneous acetic acid injection (PAI) has been reported to have a stronger cytotoxic effect and a lower rate of local recurrence than percutaneous ethanol injection (PEI) in the treatment of small HCCs [3,4]. The same authors underline that the necrosis capacity of PAI is equivalent to that of PEI at an acetic acid concentration of 15% whereas a greater killing effect is reached at a 50%. Other authors have shown that PAI is effective in the treatment of small HCCs in a single high-dose session [5]. Some authors believe that PEI necessitates more treatment sessions than PAI and has a higher rate of local recurrence [4]
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