Ethanol Injection For Hepatocellular Carcinoma Research Articles

The Islanding effect - a special method of percutaneous peritumor ethanol injection for hepatocellular carcinoma: 15-year follow-up outcome.

Percutaneous ethanol injection is a well-known ablation therapy for hepatocellular carcinoma and is well-tolerated, inexpensive, and effective with few adverse events. In this study, another type of ethanol injection was introduced in the present study.Sixty two patients with hepatocellular carcinoma received 133 percutaneous peritumor ethanol injection treatments and the 15-year follow-up outcomes were analyzed through a collected database.The technical efficiency was 89.5% (119/133 treatments) after the first percutaneous peritumor ethanol injection procedure. However, after the second repeated percutaneous peritumor ethanol injection procedure, technical efficiency increased to 98.5% (131/133 treatments). The 1 year, 3 years, 5 years, 10 years, and 15 years rates of tumor recurrence were 12.9%, 50.0%, 59.7%, 74.2%, and 74.2%, respectively. Multivariate analysis demonstrated that diabetes, Child–Pugh class B, and tumor size greater than 2 cm were significantly related to tumor recurrence. The 1 year, 3 years, 5 years, 10 years, and 15 years rates of overall survival were 98.4%, 83.6%, 61.3%, 19.4%, and 0%, respectively. Multivariate analysis demonstrated that Child–Pugh class B, tumor size greater than 2 cm, and multiple tumors were significantly related to overall survival.Compared with other ablation methods (including peritumor ethanol injection), percutaneous peritumor ethanol injection can avoid tumor ruptures, reduce tumor proliferation and metastasis, and is suitable for the treatment of small tumors. In addition, when combined with other treatment methods, percutaneous peritumor ethanol injection can form a tumor metastatic isolation zone in advance and improve the comprehensive treatment effect.

Ex-Vivo Identification of Tumor From Parenchyma in Human Liver Using Electrochemical Impedance Spectroscopy on a Needle

Percutaneous ethanol injection for hepatocellular carcinoma and biopsy for pathological examination of lesions in the liver are widely performed using a fine needle under ultrasonography guidance. However, it is often difficult to distinguish a malignant tumor from a parenchyma via ultrasonography. This study proposes a method for identifying a malignant tumor in the liver using coplanar bipolar electrodes fabricated on a fine needle, called electrochemical impedance spectroscopy on a needle (EoN). The electrical impedances of the malignant tumor and parenchyma were measured in two pathological statuses, more specifically in human ex-vivo normal liver and in human ex-vivo cirrhotic liver. Statistically significant differences in the electrical impedance between the malignant tumor and parenchyma in each pathological status were observed in a frequency range of 0.46MHz to 1MHz (p < 0.05). Given a real-time measurement in clinical trials, the optimal frequency suggested was indicated by the largest value in the discrimination index between the malignant tumor and the parenchyma. The electrical properties (conductivity and permittivity) of the tissues were estimated to generalize the sensor output without regard to the dimension and shape of the electrodes. The values of the electrical properties of cancer in the cirrhotic liver and normal liver were significantly higher than those of each parenchyma. These experimental results imply that EoN can be used as a potential tool for identification of malignant tumors in the liver during percutaneous ethanol injection and fine needle aspiration procedures.

Safety and Efficacy of Percutaneous Radiofrequency Ablation Combined with Percutaneous Ethanol Injection for Hepatocellular Carcinoma in High-risk Locations

Safety and Efficacy of Percutaneous Radiofrequency Ablation Combined with Percutaneous Ethanol Injection for Hepatocellular Carcinoma in High-risk Locations

Radiofrequency ablation combined with percutaneous ethanol injection for hepatocellular carcinoma: a systematic review and meta-analysis

Background: Radiofrequency ablation (RFA) and percutaneous ethanol injection (PEI) are important treatments for patients with hepatocellular carcinoma (HCC) who are not eligible for resection and liver transplantation. Therefore, it is important to establish comparisons between RFA, PEI and the two therapies in combination.Aims: To evaluate the clinical efficacy and safety of combined RFA-PEI versus monotherapy with either RFA or PEI for HCC to provide references for clinical practice and further research.Methods: We searched all eligible studies published before September 2015 in the Cochrane Library, PubMed, Embase, Web of Science and Chinese databases, such as CBM, CNKI, VIP and WanFang and also retrieved papers from other sources. All relevant controlled trials were collected. Meta-analyses were performed using RevMan version 5.3 software (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark).Results: Thirteen trials with 1621 patients were identified. Compared with PEI, RFA was associated with significant improvement in overall survival (OS) rate at 1, 2, 3 and 4 years, cancer-free survival (CFS) rate at 1, 2 and 3 years and complete tumour necrosis. RFA was associated with a significant reduction in the local recurrence rate at 1, 2 and 3 years. However, RFA was also associated with a higher total risk of complications. Compared with RFA alone, combined RFA-PEI was associated with a significant improvement in the OS rate at 1.5, 2 and 3 years and a significant reduction in the local recurrence rate. However, combined RFA-PEI was also associated with a higher risk of fever.Conclusion: The combination of RFA and PEI appears to be the optimal treatment strategy when considering combined RFA-PEI or either RFA or PEI alone. Combined RFA-PEI significantly improves OS and reduces the risk of local recurrence without increasing major complications. Further large-scale studies are needed to assess economic outcomes and quality of life.

Clinical outcomes of endoscopic ultrasound-guided ethanol injection for hepatocellular carcinoma in the caudate lobe.

Background and study aims: Accurately puncturing hepatocellular carcinomas (HCC) that arise from the caudate lobe is generally considered to be technically difficult. We conducted a retrospective study to evaluate the feasibility and safety (the therapeutic outcomes and adverse events) of endoscopic ultrasound (EUS)-guided ethanol injection as a novel treatment for HCC in the caudate lobe. Patients and methods: Twelve patients with early-stage HCC of the caudate lobe that were treated with EUS-guided ethanol injection at two tertiary referral centers were reviewed retrospectively. To evaluate the therapeutic effect of the treatment, a local control curve and an overall survival curve were constructed using the Kaplan–Meier method. Results: The mean follow-up duration was 31.0 months. The 1-year local control rate was 80.2 %, and recurrent lesions developed in 2 cases (after 3 and 9 months, respectively). The overall survival rate was 91.7 %, 75.0 %, and 53.3 % at 1, 2, and 3 years, respectively. Concerning procedure-related adverse events (AEs), 2 patients suffered episodes of fever lasting a few days; however, no serious AEs occurred. Conclusions: EUS-guided ethanol injection could be a useful treatment for early-stage HCC in the caudate lobe because of its simplicity and reduced invasiveness.

M-RECIST at 1 month and Child A are survival predictors after percutaneous ethanol injection of hepatocellular carcinoma

Background and aims. Percutaneous ethanol injection (PEI) is a well-established therapeutic option in patients with cirrhosis and hepatocellular carcinoma (HCC). The modified-Response Evaluation Criteria in Solid Tumors (m-RECIST) are an important tool for the assessment of HCC response to therapy. The aim was to evaluate whether HCC response according to the m-RECIST criteria could be an effective predictor of long-term survival in Barcelona Clinic Liver Cancer (BCLC) stage 0 and A HCC patients undergoing PEI.Material and methods. 79 patients were followed-up for median time of 26.8 months. HCC diagnosis was based on the current guidelines of the American Association for Study of the Liver Diseases (AASLD) and European Association for Study of the Liver (EASL). Patient survival was calculated from the first PEI session to the end of the follow-up.Results. The 1-, 3-, and 5-year overall survival rates were 79, 48 and 37%, respectively. In the multivariate analysis, Child-Pugh-Turcotte (CPT) (p = 0.022) and the response to m-RECIST criteria (p = 0.016) were associated with patient survival. CPT A patients who achieved Complete Response (CR) 1 month after PEI presented a 5-year survival rate of 55%. By contrast, the worst scenario, the group with CPT B but without CR had a 5-year survival rate of 9%, while the group with either CPT A or CR as a survival predictor had a 5-year survival rate of 31%. In conclusion, in BCLC stage 0 and A HCC-patients, m-RECIST at 1 month and Child A may predict survival rates after PEI.

Benefits of Percutaneous Ethanol Injection in the Palliative Treatment of Advanced Hepatocellular Carcinoma.

Hepatocellular carcinoma (HCC) is a devastating disease in which survival is measured in months rather than years from the time of diagnosis. The aggressive nature of the tumour and the usual background chronic liver disease make the management difficult warranting multidisciplinary cooperation. Percutaneous ethanol injection (PEI) was introduced ten years ago as palliative therapy for patients with inoperable hepatocellular carcinoma. Objective: This study was aimed at evaluating the benefits of percutaneous ethanol injection in the management of advanced hepatocellular carcinoma. Patients and methods: Consecutive patients who had percutaneous ethanol injection for hepatocellular carcinoma at Adoose specialist hospital from August 2008 to July 2012 were prospectively analysed and formed the basis of this study. Results :A total of 32 patients had (PEI) during the study period out of an initial 82 that presented with HCC. The mean age of the study population was 40.4+/- 14.2yrs with age range of 18 to 60yrs. There were 28(87.5%) males and 4(12.5%) females giving a male: female ratio of 7:1. Right hypochondrial pain and mass were the main symptoms seen in 28(87.5%). Pre intervention pain score ranges from 6-8 while post intervention pain score a week after treatment dropped to 1 or 2. The longest survivor at follow up with this treatment is 14months with mean survival duration of 8months.Conclusion: Percutaneous ethanol injection significantly reduces the pain of advanced hepatocellular carcinoma and prolongs survival.

Percutaneous ethanol injection for hepatocellular carcinoma: 20‐year outcome and prognostic factors

BackgroundEthanol injection is the best-known image-guided percutaneous ablation for hepatocellular carcinoma (HCC) and a well-tolerated, inexpensive procedure with few adverse effects. However, there have been few reports on its long-term results.AimsWe report a 20-year consecutive case series at a tertiary referral centre.MethodsWe performed 2147 ethanol injection treatments on 685 primary HCC patients and analysed a collected database.ResultsFinal computed tomography demonstrated complete ablation of treated tumours in 2108 (98.2%) of the 2147 treatments. With a median follow-up of 51.6 months, 5-, 10- and 20-year survival rates were 49.0% [95% confidence interval (CI) = 45.3–53.0%], 17.9% (95% CI = 15.0–21.2%) and 7.2% (95% CI = 4..5–11.5%) respectively. Multivariate analysis demonstrated that age, Child–Pugh class, tumour size, tumour number and serum alpha-fetoprotein level were significant prognostic factors for survival. Five-, 10- and 20-year local tumour progression rates were 18.2% (95% CI = 15.0–21.4%), 18.4% (95% CI = 15.2–21.6%) and 18.4% (95% CI = 15.2–21.6%) respectively. Five-, 10- and 20-year distant recurrence rates were 53.5% (95% CI = 49.4–57.7%), 60.4 (95% CI = 56.3–64.5%) and 60.8% (95% CI = 56.7–64.9%) respectively. There were 45 complications (2.1%) and two deaths (0.09%).ConclusionsEthanol injection was potentially curative for HCC, resulting in survival for more than 20 years. This study suggests that new ablation therapies will achieve similar or even better long-term results in HCC.

Clinical evaluation of ultrasound-guided percutaneous microwave ablation of hepatocellular carcinoma adjacent to the gastrointestinal tract

The purpose of the study was to prospectively evaluate safety and assisted with ethanol injection for hepatocellular carcinoma abutting gastrointestinal tract. 263 patients with 319 hepatic tumors that underwent percutaneous microwave ablation with curative intention were included. 101 lesions located less than 5 mm from gastrointestinal tract were in gastrointestinal group. 218 lesions located more than 5 mm from hepatic surface, gastrointestinal tract and first or second branch of hepatic vessels were in control group. The temperature of marginal ablation tissue proximal to gastrointestinal tract was monitored and controlled to fluctuating between 45 degrees C and 59 degrees C for more than 10 min for tumors in the gastrointestinal group. Ethanol (1-21 ml) was injected into marginal tissue in 62 of 101 lesions of the G1 group. 96 of 101 tumors (95.0%) in the gastrointestinal group and 208 of 218 tumors (95.4%) in the control group achieved complete ablation (P = 0.89). Local tumor progression for all the tumors were in the first year and the 6-,12- month local tumor progression rate in the gastrointestinal group and the control group were 6.9%, 11.9% and 7.3%, 8.3%, respectively (P = 0.21). There were neither immediate nor periprocedural complications in both groups. There was no delayed complication of gastrointestinal and bile ducts injury. Tumor seeding happened in one (1.1%) of the gastrointestinal group and three (1.8%) of the control group (P = 0.92). Under strict temperature monitoring, microwave ablation assisted with ethanol injection is safe and achieves a high complete ablation rate for hepatocellular carcinoma adjacent to gastrointestinal tract.

Portal vein thrombosis after percutaneous ethanol injection of hepatocellular carcinoma

Portal vein thrombosis after percutaneous ethanol injection of hepatocellular carcinoma

Combined Percutaneous Radiofrequency Ablation and Ethanol Injection for Hepatocellular Carcinoma in High-Risk Locations

The purpose of this study was to investigate whether combining percutaneous ethanol injection (PEI) with radiofrequency ablation in the management of hepatocellular carcinoma (HCC) in high-risk locations improves treatment outcomes. We compared the outcome of management of high-risk tumors with PEI and radiofrequency ablation (n = 50) or radiofrequency ablation alone (n = 114) with the outcome of radiofrequency ablation of non-high-risk tumors (n = 44). We also compared the survival rates of patients with and those without high-risk HCC. PEI was performed into the part of the tumor closest to a blood vessel or vital structure before radiofrequency ablation. The study included 142 patients with 208 HCCs managed with radiofrequency ablation. Despite larger tumor sizes (2.8 +/- 1 cm vs 1.9 +/- 0.7 cm vs 2.5 +/- 0.1 cm for the high-risk radiofrequency plus PEI, non-high-risk radiofrequency, and high-risk radiofrequency groups, respectively; p < 0.001), the primary effectiveness rate of high-risk radiofrequency ablation and PEI (92%) was similar to that of non-high-risk radiofrequency ablation (96%). The primary effectiveness rate of high-risk radiofrequency ablation and PEI was slightly higher (p = 0.1) than that of high-risk radiofrequency ablation (85%). The local tumor progression rates (21% vs 33% vs 24% at 18 months) of the three respective groups were not statistically different (p = 0.91). Patients with and those without high-risk tumors had equal survival rates (p = 0.42) after 12 (87% vs 100%) and 24 (77% vs 80%) months of follow-up. Independent predictors of primary effectiveness were a tumor size of 3 cm or less (p = 0.01) and distinct tumor borders (p = 0.009). Indistinct borders (p = 0.033) and non-treatment-naive status of HCC (p = 0.002) were associated with higher local tumor progression rates. The only predictor of survival was complete ablation of all index tumors (p = 0.001). The combination of radiofrequency ablation and PEI in the management of HCC in high-risk locations has a slightly higher primary effectiveness rate than does radiofrequency ablation alone. A randomized controlled study is warranted.

Transcatheter Arterial Chemoembolization and Percutaneous Ethanol Injection for Hepatocellular Carcinoma: A Retrospective Review of the Veterans Affairs Caribbean Healthcare System

Hepatocellular carcinoma (HCC) is a common malignancy worldwide and has a poor prognosis. Although surgery and liver transplantation provide better outcomes, most patients are not candidates due to advanced disease, lack of donor availability, or presence of comorbidities. Several percutaneous approaches such as transcatheter arterial chemoembolization (TACE) and percutaneous ethanol injection therapy (PEIT) have been developed for local control and can potentially increase survival in these patients. We retrospectively reviewed 33 patients with HCC who were treated with TACE, PEIT, or both from 2000 to 2005 at the VA Caribbean Healthcare System in Puerto Rico to evaluate tolerability, response, and survival. Patients were evaluated with cross-sectional computed tomography imaging to determine response using response evaluation criteria in solid tumors (RECIST). Thirty-three men with a mean age of 66 years were treated. Mean tumor size was 5.6 cm, ranging from 2 cm to 16 cm. All patients had cirrhosis, with alcohol abuse and hepatitis C as the most common etiologies. Objective radiographic partial response was observed in 28% of patients and 48% had disease stabilization. Most of the patients had a therapeutic response demonstrated by necrosis of the tumor and decreased contrast enhancement. Patients who underwent both TACE and PEIT had a higher response rate and disease stabilization but no difference in survival compared with those who received TACE or PEIT alone. Median survival for the whole group was 2 years. Causes of death included tumor progression, hepatic failure, gastrointestinal bleeding, and infections. The initial tumor size and Child-Pugh class did not confer a significant difference in survival rate. In Puerto Rico, where liver transplantation is not performed at present, percutaneous treatments are effective local therapies for patients who are not candidates for surgery and who have disease limited to the liver.

MR‐guided percutaneous ethanol ablation of hepatocellular carcinomas before liver transplantation

It was the objective of this study to evaluate MR‐guided, percutaneous ethanol injection of hepatocellular carcinoma in ten patients scheduled for liver transplantation. Using a 0.2 T open MR scanner (Magnetom Open, Siemens Medical Systems, Erlangen, Germany) and percutaneous instillation of ethanol, 12 liver tumors (median tumor volume, 6.3; range, 0.6–43.2 ccm) were treated. Coagulation necrosis, morbidity, and post‐transplant histology were assessed. No major complications were observed. A mean of 16.4±11.4 ml ethanol was injected for each tumor. The median volume of the ablation necrosis was 12.3 (range, 0.3–48.3) ccm. Three tumors were retreated and complete radiological necrosis before liver transplantation was found in eight of 12 tumors (67%). One patient developed multifocal disease and was excluded from transplantation; thus nine of ten patients underwent liver transplantation within 3.9±3.1 months. In the explants, satellite nodules (n = 2), new liver tumors (n = 2) and a complete necrosis were found in five of 12 treated tumors (42%). During follow‐up (median 41.3; range, 0.4–86.1 months), three patients died, but no tumor‐seeding or post‐transplantation recurrence occurred. MR‐guided ethanol injection is feasible, and may delay tumor progression. However, the local recurrence rate is high, and the spatial resolution of a low‐field MR scanner limits the detection of small tumors.

MR‐guided percutaneous ethanol injection for hepatocellular carcinoma in a 0.2T open MR system

The purpose of this work is to describe our experience with single-session percutaneous ethanol injection (PEI) under the guidance of 0.2-T open MRI for hepatocellular carcinomas (HCC) that were not suitable for ablation under ultrasound (US) or computed tomography (CT) guidance. None of the lesions (N = 7) were detectable on US. MRI was chosen over CT as the guidance modality because the nodules were located in the hepatic dome (N = 4) or were invisible on noncontrast CT (N = 3). All of the nodules were targeted successfully, and apparently complete tumor necrosis was achieved in six nodules (86%). During a follow-up of one to 41 months, only one patient developed local recurrence four months after PEI. MR-guided PEI is feasible and effective for treating HCC when other imaging guidance methods are not appropriate.

Radiofrequency ablation improves prognosis compared with ethanol injection for hepatocellular carcinoma ≤4 cm

The aim of this study was to compare the clinical outcome of percutaneous radiofrequency (RF) ablation, conventional percutaneous ethanol injection (PEI), and higher-dose PEI in treating hepatocellular carcinoma (HCC) 4 cm or less. A total of 157 patients with 186 HCCs 4 cm or less were randomly assigned to 3 groups (52 patients in the conventional PEI group, 53 in the higher-dose PEI group, and 52 in the RF group). Clinical outcomes in terms of complete tumor necrosis, overall survival, local tumor progression, additional new tumors, and cancer-free survival were compared across 3 groups. The rate of complete tumor necrosis was 88% in the conventional PEI group, 92% in the higher-dose PEI group, and 96% in the RF group. Significantly fewer sessions were required to achieve complete tumor necrosis in the RF group than in the other 2 groups (P < .01). The local tumor progression rate was lowest in the RF group (vs the conventional PEI group, P = .012; vs the higher-dose PEI group, P = .037). The overall survival rate was highest in the RF group (vs the conventional PEI group, P = .014; vs the higher-dose PEI group, P = .023). The cancer-free survival rate was highest in the RF group (vs the conventional PEI group, P = .019; vs the higher-dose PEI group, P = .024). Multivariate analysis determined that tumor size, tumor differentiation, and the method of treatment (RF vs both methods of PEI) were significant factors in relation to local tumor progression, overall survival, and cancer-free survival. The results show that RF ablation yielded better clinical outcomes than conventional and higher-dose PEI in treating HCC 4 cm or less.

Comparison of Percutaneous Acetic Acid Injection and Percutaneous Ethanol Injection for Hepatocellular Carcinoma in Cirrhotic Patients: A Prospective Study

Background: Ultrasound-guided percutaneous ethanol injection (PEI) and percutaneous acetic acid injection (PAI) are effective in the treatment of hepatocellular carcinoma (HCC). We conducted a prospective study to compare the therapeutic efficacy of both these methods. Methods: Sixty-three patients were treated by PAI using 50% acetic acid and 62 by PEI using pure ethanol. There were no significant baseline differences in age, sex, Child-Pugh class, tumour size and number, or other clinico-biochemical parameters between the two groups. Results: During a follow-up period of 24 ± 9 (range 6-38) months, 19 (30%) of the PAI group and 21 (34%) of the PEI group died ( P r = r 0.704). The 1- and 3-year survival rates were 84% and 51% for the PAI group and 81% and 46% for the PEI group ( P r = r 0.651). The corresponding tumour recurrence rates were 51% and 74% for the PAI group, and 54% and 64% for the PEI group ( P r = r 0.787). The treatment sessions were 3.9 ± 1.6 and 6.2 ± 2.3 for the PAI and PEI groups, respectively, in each treatment cycle ( P r = r 0.008). A multivariate analysis using the Cox regression model revealed that ascites (relative risk (RR) 3.1, 95% confidence interval (CI) 1.5-6.3, P r = r 0.002), large (>3 r cm) or multinodular HCCs (RR 2.4, 95% CI 1.1-5.4, P r = r 0.04), and development of tumour recurrence (RR 7.0, 95% CI 3.1-16.0, P r < r 0.001) were independent, poor prognostic factors in both groups. Conclusions: PAI and PEI are equally effective in the treatment of HCC. PAI has the advantage of fewer treatment sessions in each treatment course. Careful pretreatment patient selection may improve survival.

Early detection of haemobilia associated with percutaneous ethanol injection for hepatocellular carcinoma.

Haemobilia often results from iatrogenic injury caused by therapeutic procedures. The objective of this study was to evaluate the efficacy of early diagnosis of haemobilia based on ultrasonography in patients with hepatocellular carcinoma undergoing percutaneous ethanol injection. A combination retrospective and prospective study on the early detection of haemobilia caused by percutaneous ethanol injection was conducted on 365 patients in 1995-1996. The retrospective study reviewed the clinical, laboratory and imaging data of 172 patients who had undergone ethanol injection therapy in 1995. The results showed that ultrasonographic changes in the gallbladder, namely the rapid appearance of echogenic material in the gallbladder lumen, are a useful early sign of haemobilia. Based on the results of the retrospective study, a prospective study on the early detection of haemobilia was carried out in 1996. In the prospective study, percutaneous ethanol injection was halted as soon as haemobilia was detected. The incidence of haemobilia in the prospective group (3.6%) was not different from that in the retrospective group (4.7%). However, the mean duration between percutaneous ethanol injection and diagnosis of haemobilia was only 0.3 +/- 0.2 days in the prospective group, compared with 2.8 +/- 2.1 days in the retrospective group (P < 0.001), and the mean duration of jaundice in the prospective group (4.3 days) was significantly shorter than in the retrospective group (40.0 days) (P< 0.05). Early diagnosis of haemobilia based on ultrasonographic findings of the gallbladder lumen effectively reduces the severity of haemobilia-related complications due to immediate interruption of the interventional procedure.

CT fluoroscopy-assisted needle puncture and ethanol injection for hepatocellular carcinoma: a preliminary study.

We assessed the usefulness of real-time CT fluoroscopy for needle guidance and evaluated the clinical usefulness of a unified CT fluoroscopy and angiography system in the treatment of hepatocellular carcinoma. A single-session percutaneous ethanol injection was performed with CT fluoroscopy guidance and monitoring for 15 hepatocellular carcinomas with an average size of 2.5 cm (range, 0.7-4.7 cm) in 10 consecutive patients. Of these, seven lesions were not seen on sonography. To mark the lesion for puncture, we performed CT arteriography or arterial injection of iodized oil. A puncture guide was applied to 12 lesions. The average depth from the skin's surface to the lesion was 9.3 cm (range, 4.5-11.5 cm), and the puncture route was transthoracic in five lesions and transabdominal in 13. The overall success rate in puncturing the lesions was 94.4% (17/18 sessions). The average number of punctures was 3.3, and it significantly decreased after introduction of a puncture guide compared with freehand puncture (p < .01). The average amount of injected ethanol was 12.7 ml (range, 4-27 ml). The ratio of injected ethanol dose to calculated ethanol dose was 0.6. Local recurrence occurred in four (26.7%) of 15 lesions after an average of 5 months. Using CT fluoroscopy for guidance of the needle and for monitoring ethanol infusion in the target lesion, we have found single-session percutaneous ethanol injection to be possible for hepatocellular carcinomas smaller than 5 cm or not revealed by sonography. The puncture guidance equipment was helpful for accurate insertion of the needle into the lesion, allowing a minimum number of punctures and minimal radiation exposure.

Use of FDP and F1P aldolase to detect tumorous and nontumorous tissue damage by ethanol injection of hepatocellular carcinoma.

Changes in serum levels of tumor-specific fructose 1,6-diphosphate (FDP) aldolase and nontumor-specific fructose 1-phosphate (F1P) aldolase activities were analyzed in patients with hepatocellular carcinoma (HCC) to detect the damage of tumorous and nontumorous hepatic cells after percutaneous ethanol injection (PEI). Initial PEI was performed in 20 patients containing 22 HCC nodules with a diameter of < or = 4 cm. Changes in serum hepatic enzyme activities were measured before and after repeated PEI. FDP and F1P aldolase levels were measured by substrate-specific enzymatic methods. Pre- and posttreatment alpha-fetoprotein (AFP) levels were determined by radioimmunoassay. The consequent changes in the total nontumorous liver volumes after PEI were also analyzed by follow-up CT scans. Serum levels of FDP aldolase released by ethanol injection were progressively increased (P < 0.0001) until the third PEI and thereafter decreased. In contrast, serum levels of F1P aldolase were continuously elevated even after the third PEI (P < 0.0001). Serum levels of transaminases were also elevated after repeated PEI (P < 0.0001). The FDP/FIP aldolase ratio decreased significantly with increased volume (>20 ml) of injected ethanol (P = 0.01) caused by nontumorous liver damage. The elevation of FDP aldolase was markedly associated with a decrease in serum levels of AFP (P < 0.001), indicating adequate tumor necrosis. The progression of the total nontumor liver atrophy depended on the volume of injected ethanol and correlated significantly with F1P aldolase levels after PEI (P < 0.01) but not with FDP aldolase. These results demonstrated that caution is needed to avoid nontumorous liver damage caused by the large volume of ethanol injection in treating HCC. Measurement of FDP and F1P aldolase activities in serum after PEI is clinically useful to detect the degree of tumorous and nontumorous tissue damage by ethanol.

Complete ablation of color doppler signals to evaluate response to treatment with percutaneous ethanol injection for hepatocellular carcinoma

Complete ablation of color doppler signals to evaluate response to treatment with percutaneous ethanol injection for hepatocellular carcinoma