Percutaneous Acetic Acid Injection Research Articles

Population-based matching comparison between radiofrequency ablation and percutaneous ethanol or acetic acid injection for hepatocellular carcinoma

BackgroundLoco-regional therapies are evolving for hepatocellular carcinoma (HCC) treatment. Radiofrequency ablation (RFA) has changed the landscape in treating HCC; however, percutaneous ethanol or acetic acid injection (PEI/PAI) remains a widely used and easily performed technique by experienced clinicians. Nevertheless, the effectiveness of RFA compared to that of PEI/PAI remains unclear. MethodsRecords of 73,136 patients with newly diagnosed HCC between 2007 and 2013 were drawn from the Taiwan Cancer Registry. The primary outcome measures were the overall survival and local recurrence-free survival. Propensity score matching (PSM) was performed to compare the effectiveness of RFA and PEI. Median follow-up time was 61.6 months (36–120 months). ResultsAfter PSM, 4496 patients diagnosed with stage I-III HCC, who were initially treated with RFA (3372 patients) or PEI/PAI (1124 patients), were assessed. Compared to PEI/PAI, patients treated with RFA had better 5- and 9-year overall survival, cancer-specific survival, disease-free survival, and local recurrence-free survival. Median overall survival and recurrence-free survival of patients treated with RFA vs PEI/PAI were 61.5 vs 41.9 months and 72.1 vs 45.2 months, respectively. Multivariate Cox model analysis revealed that, except for patients with high cell grade or advanced stage, RFA resulted in better overall survival (HR: 0.74, 95% CI 0.68–0.81, P < 0.001) and local recurrence-free survival (HR: 0.69, 95% CI 0.63–0.75, P < 0.001) than PEI/PAI. ConclusionsRFA provides advantages over conventional PEI/PAI for HCC. Considering technological advances in instruments, loco-regional therapies for HCC can be employed in carefully selected patients.

A Randomized Control Trial of Thromboelastography-Guided Transfusion in Cirrhosis for High-Risk Invasive Liver-Related Procedures.

Hemostasis in cirrhosis is dynamic and balanced. Thromboelastography (TEG) assesses global coagulation status. We aimed to assess whether TEG-guided blood product transfusions result in lower blood product requirements in patients with cirrhosis undergoing invasive liver-related procedures as compared to the conventional standard of care (SOC). In this open-label, randomized controlled trial, cirrhosis patients with coagulopathy, undergoing invasive liver-related procedures, were randomized to either TEG-guided blood product transfusion or SOC. The primary outcome was difference in the amount of fresh frozen plasma (FFP) and platelet units transfused between the two groups. The secondary outcome was procedure-related bleeding complications within 5days and any complications until 28days. From November 2017 till June 2019, 58 patients were recruited (29: TEG and 29: SOC). Most common procedures performed were percutaneous liver biopsy (n = 48), followed by transjugular intrahepatic portosystemic shunt (n = 2), percutaneous acetic acid injection (n = 2), and transarterial chemoembolization (n = 2). There were no differences in baseline demographics, hemostatic profile, and types of procedures between the two groups. Only nine patients in TEG group received transfusions compared to all patients in SOC (31% vs 100%; P < 0.001). In TEG group, six (20.7%) received FFP (P = 0.753 vs. SOC), two (6.9%) received platelets (P < 0.001 vs. SOC), and 1(3.4%) patient received both FFP and platelet (P ≥ 0.999 vs. SOC) transfusion. None of the patients in either group developed procedure-related bleeding complications until 5days post-procedure. The complication rates at 28-day follow-up were similar between the groups. TEG-guided blood product transfusion strategy reduces blood product transfusion without increased risk of bleeding in cirrhotic patients undergoing invasive liver-related procedures (CTRI/2017/12/010822).

Comparative Study between Radiofrequency Ablation Combined with either Percutaneous Ethanol Injection or Percutaneous Acetic Acid Injection in the Management of Hepatocellular Carcinoma.

Background and study aim: Radio-frequency ablation (RFA) has attracted the greatest interest because of its effectiveness and safety. However, complete tumor necrosis rate with RFA for tumors larger than 5 cm is less favorable. Acetic acid, which has the ability to penetrate cells with the property of extracting collagen and dissolving lipids, has a stronger killing effect on hepatocytes than ethanol. The aim of this study was to compare two percutaneous combined therapies, RFA plus percutaneous ethanol injection (PEI) and RFA plus percutaneous acetic acid injection (PAI) in hepatocellular carcinoma (HCC) treatment in patients having single focal lesions more than five and up to seven cm in diameter. Patients and Methods: The patients were selected according to the triphasic CT scanning characteristics of HCC. They were randomly allocated into 2 groups: GI included 30 patients who were candidates for 1 setting of RFA then PEI in the same setting. GII included 30 patients ;they were ablated by 1 setting of RFA with 2 overlaps to decrease the size of the remaining unablated areas, then PAI in the same setting. Results: Evaluation of the response one month later using triphasic CT showed significant better responses in GII compared to GI (83.3% vs 60%) with P value <0.05. The response 3 months later was not changed significantly compared to the response after one month of the procedure (56.7% in GI and 80% in GII) Conclusion: Ablation of inoperable large HCC 5.1-7cm can be done with combined techniques. RFA plus acetic acid was compared to RFA plus ethyl alcohol. Complete ablation was superior when acetic acid was used.

Comparative efficacy and safety between ablative therapies or surgery for small hepatocellular carcinoma: a network meta-analysis

ABSTRACTBackground: Major treatments for small hepatocellular carcinoma (SHCC) include percutaneous ethanol injection (PEI), percutaneous acetic acid injection (PAI), radiofrequency ablation (RFA), or surgical resection (SR). We aimed to compare these therapies concerning with effectiveness and safety.Methods: Cochrane Library, PubMed, and Embase were searched for randomized controlled studies (RCTs) from inception to 30 April 2017. Odds ratios (OR) for proportion dead (PD), local recurrence (LR) and adverse events (AEs).Results: Fourteen RCTs were identified. Compared with SR, PEI (OR 2.79, CrI 1.25, 6.45, p < 0.01) provided a significantly increased risk of PD. Similarly, PEI (OR 4.29, CrI 1.18, 18.35, p < 0.01) yielded more LR than SR. Also, SR significantly conferred more AEs than RFA (OR 0.10; CrI 0.02, 0.35, p < 0.01), PEI (OR 0.06; CrI 0.01, 0.31, p < 0.01). Besides, RFA conferred the highest efficacy for survival, time to recurrence, and new development of HCC.Conclusions: SR was superior to PEI. Although SR achieved highest cumulative ranking probabilities in clinical efficacy, it obtained a low benefit-to-risk ratio for patients. RFA was superior to the other ablative therapies. For tumor sizes > 2 cm or ≤ 2 cm in diameter, SR conferred non-significant effects compared with other therapies for SHCC.

What is the best combination treatment with transarterial chemoembolization of unresectable hepatocellular carcinoma? a systematic review and network meta-analysis.

ObjectiveTo assess the comparative efficacy and safety of combination treatment with transarterial chemoembolization (TACE) for patients with unresectable hepatocellular carcinoma (HCC) through a systematic review and network meta-analysis and to identify what is the best combination treatment with TACE.Materials and MethodsA network meta-analysis was used to identify evidence from relevant randomized controlled trials. We searched databases for publications up to June 2017. The prespecified primary efficacy outcomes were treatment response and 6-month to 3-year overall survival (OS), while the secondary efficacy outcomes were 1- and 2-year disease-free survival (DFS); safety outcomes were advance effects of combination treatment. We conducted pairwise meta-analyses using a random-effects model and then performed random-effects network meta-analyses.ResultsA total of 48 trials were eligible (50 analyses), involving 5627 patients and 19 treatment arms. In comparison with other types of combination therapy arms, network meta-analysis disclosed that TACE + three-dimensional conformal radiotherapy, TACE + percutaneous ethanol injection, TACE + percutaneous microwave coagulation therapy, TACE + percutaneous acetic acid injection, and TACE + sorafenib were the more effective methods in treatment response, 6-month to 3-year OS, and 1–2 year DFS; the adverse effects of TACE + sorafenib were serious. The study was registered with PROSPERO, number CRD42017071102.ConclusionsWhen considering the efficacy, combination therapy with TACE seemed to offer clear advantages for patients with unresectable HCC. TACE + Three-dimensional conformal radiotherapy, TACE + Percutaneous ethanol injection, TACE + Percutaneous microwave coagulation therapy, and TACE + Percutaneous acetic acid injection are likely the best options to consider in the application of combination treatment.

Role of Diffusion Weighted Imaging in Assessment of Tumor Response After Loco-regional Therapy in Patients of Hepato-Cellular Carcinoma

Background and Aim: Diffusion Weighted Imaging (DWI) has been found to be useful in liver mass characterisation. Its role in post-treatment evaluation has not been adequately explored. While dynamic contrast-enhanced magnetic resonance imaging (DCE—MRI) is the standard of evaluation for post-treatment response, DWI can potentially differentiate between viable and non-viable tissue and hence may be useful. This study was designed to evaluate the sensitivity and specificity of DWI in response assessment after loco-regional therapy for HCC. Methods: A prospective study was done between January 2009 and January 2017. Patients of HCC who presented to our liver clinic and undergoing loco-regional therapy [trans- arterial chemo-embolisation (TACE)/ablation techniques including radio-frequency ablation (RFA), percutaneous acetic acid injection (PAI)] were included. Four weeks post-treatment, DCE-MRI was performed using VIBE sequences to ascertain treatment response of index mass, based on m-RECIST criteria and DWI to look for presence/absence of diffusion restriction. DCE-MRI was the gold-standard. If partial response (PR) was detected on DCE-MRI, a repeat session of the earlier treatment was done followed by repeat DCE-MRI at 4 weeks (each evaluation being one observation). Results: HCC patients (n = 44) including 33 males, 11 females, having mean age 51.8 ± 14.6 years were included and underwent repetitive evaluation of 62 nodules. Post-therapeutic (54 TACE, 4 RFA and 4 PAI) response evaluation was done. DCE-MRI showed contrast enhancement in 15/62(24.2%) nodules (PR), while diffusion restriction was seen in 13/15(86.7%) of these nodules. No enhancement was seen in 47/62(75.8%) nodules (complete response), of which 37/47(78.7%) showed no restriction, while 10/47(21.3%) showed restricted diffusion. DWI thus showed a sensitivity of 86.7% and specificity of 78.7%. Conclusion: DWI shows good sensitivity and moderate specificity for assessing response in HCC after loco-regional therapy. Although DWI cannot be a standalone for post- treatment response assessment, it may be useful as an adjunct to DCE-MRI. The authors have none to declare.

Management of people with early- or very early-stage hepatocellular carcinoma: an attempted network meta-analysis.

Management of people with early- or very early-stage hepatocellular carcinoma: an attempted network meta-analysis.

Percutaneous injection of Acetic Acid and Mitoxantrone Versus Radiofrequency Ablation in Treatment of Hepatocellular Carcinoma

Background and study aim :Hepatocellular carcinoma (HCC) is currently the fifth most common solid tumor worldwide and the third leading cause of cancer-related death. New therapeutic choices have been developed for HCC, including percutaneous ablation therapy, transarterial chemoembolization and molecular target therapy. Percutaneous acetic acid injection (PAI) and radio-frequency ablation (RFA) techniques became well-known procedures for controlling small HCC.The aim of this study was to compare the outcomes of per-cutaneous combined PAI and mitoxantrone injection versus RFA in the treatment of HCC.. Patients and Methods:This prospective study was conducted on 120 patients with 120 focal nodular HCCs of 4 cm or less between 2012 and 2014. They were randomly divided into 2 groups, the first group included 60 patients treated with PAI plus percutaneous intratumoral injection of mitoxantrone, and the second group included 60 patients treated with radio-frequency ablation. Clinical assessment, laboratory evaluation and triphasic CT studies were performed to all patients pre-treatment and at 1,3,6 and 12 months post treatment and complications were recorded. Results: The percentage of ablation in both groups at 1, 3, 6 and 12 months were 85%, 83.33%,78.34 and 73.33% in group I versus 88.33%, 88.3%, 85% and 81.66% in group II respectively with no statistical significant difference between the two groups. Percentage of ablation in small tumors was higher than large tumors in both groups. Side effects and complications are statistically higher in group II than group I. Conclusion: Combination of PAI and Mitoxantrone is comparable to radiofrequency ablation in treatments of HCCs with less frequent complications.

Percutaneous ethanol injection or percutaneous acetic acid injection for early hepatocellular carcinoma.

Percutaneous ethanol injection or percutaneous acetic acid injection for early hepatocellular carcinoma.

Radiofrequency (thermal) ablation versus no intervention or other interventions for hepatocellular carcinoma

Hepatocellular carcinoma is the fifth most common cancer worldwide. Percutaneous interventional therapies, such as radiofrequency (thermal) ablation (RFA), have been developed for early hepatocellular carcinoma. RFA competes with other interventional techniques such as percutaneous ethanol injection, surgical resection, and liver transplantation. The potential benefits and harms of RFA compared with placebo, no intervention, chemotherapy, hepatic resection, liver transplantation, or other interventions are unclear. To assess the beneficial and harmful effects of RFA versus placebo, no intervention, or any other therapeutic approach in patients with hepatocellular carcinoma. We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and ISI Web of Science to September 2012. We handsearched meeting abstracts from ASCO, ESMO, AASLD, EASL, APASL, and references of articles. We also contacted researchers in the field (last search September 2012). We considered for inclusion randomised clinical trials investigating the effects of RFA versus placebo, no intervention, or any other therapeutic approach on hepatocellular carcinoma patients regardless of blinding, language, and publication status. Two review authors independently performed the selection of trials, assessment of risk of bias, and data extraction. We contacted principal investigators for missing information. We analysed hazard ratios (HR) as relevant effect measures for overall survival, two-year survival, event-free survival, and local recurrences with 95% confidence intervals (CI). In addition, we analysed dichotomous survival outcomes using risk ratios (RR). We used trial sequential analysis to control the risk of random errors ('play of chance'). We identified no trials comparing RFA versus placebo, no intervention, or liver transplantation. We identified and included 11 randomised clinical trials with 1819 participants that included four comparisons: RFA versus hepatic resection (three trials, 578 participants); RFA versus percutaneous ethanol injection (six trials, 1088 participants) including one three-armed trial that also investigated RFA versus acetic acid injection; RFA versus microwave ablation (one trial, 72 participants); and RFA versus laser ablation (one trial, 81 participants). Ten of the eleven included trials reported on the primary outcome of this review, overall survival. Rates of major complications or procedure-related deaths were reported in 10 trials. The overall risk of bias was considered low in five trials and high in six trials. For a subgroup analysis, we included only low risk of bias trials. Regarding the comparison RFA versus hepatic resection, there was moderate-quality evidence from two low risk of bias trials that hepatic resection seems more effective than RFA regarding overall survival (HR 0.56; 95% CI 0.40 to 0.78) and two-year survival (HR 0.38; 95% CI 0.17 to 0.84). However, if we included a third trial with high risk of bias, the difference became insignificant (overall survival: HR 0.71; 95% CI 0.44 to 1.15). With regards to the outcomes event-free survival and local progression, hepatic resection also yielded better results than RFA. However, the number of complications was higher in surgically treated participants (odds ratio (OR) 8.24; 95% CI 2.12 to 31.95). RFA seemed superior to percutaneous ethanol or acetic acid injection regarding overall survival (HR 1.64; 95% CI 1.31 to 2.07). The RR for mortality was also in favour of RFA, but did not reach statistical significance (150/490 (30.6%) people in the percutaneous ethanol or acetic acid group versus 119/496 (24.0%) people in the RFA group; RR 1.76; 95% CI 0.97 to 3.22). The proportion of adverse events did not differ significantly between RFA and percutaneous ethanol or acetic acid injection (HR 0.70; 95% CI 0.33 to 1.48). Trial sequential analyses revealed that the number of participants in the included trials was insufficient and that more trials are needed to assess the effects of RFA versus other interventions. The effects of RFA versus no intervention, chemotherapeutic treatment, or liver transplantation are unknown. We found moderate-quality evidence that hepatic resection is superior to RFA regarding survival. However, RFA might be associated with fewer complications and a shorter hospital stay than hepatic resection. We found moderate-quality evidence showing that RFA seems superior to percutaneous ethanol injection regarding survival. There were too sparse data to recommend or refute ablation achieved by techniques other than RFA. More randomised clinical trials with low risk of bias and low risks of random errors assessing the effect of RFA are needed.

Recurrence of primary aldosteronism after percutaneous ethanol injection

Adrenalectomy is the definite treatment for aldosterone-producing adenoma (APA). Percutaneous ethanol or acetic acid injection with computed tomography (CT) guidance has been described as a safe, noninvasive, and effective alternative treatment modality in patients with high surgical risk. We report on a man who was 49 years of age and presented with treatment-resistant hypertension and was later diagnosed with APA. CT-guided percutaneous ethanol injection (PEI) was performed for this high surgical risk patient. He had aldosteronism recurrence 4 years after the ethanol injection, so a second PEI was performed. The tumor size was reduced and his blood pressure was normalized. Therefore, we suggest that clinicians should closely check aldosterone to renin ration and potassium level if percutaneous chemical ablation is considered in functioning adrenal adenomas.

Radiofrequency ablation or percutaneous ethanol injection for the treatment of liver tumors

The liver is a common location of both primary and secondary malignancies. For unresectable liver cancer, many local ablative therapies have been developed. These include e.g., percutaneous ethanol injection (PEI), percutaneous acetic acid injection, radiofrequency ablation (RFA), cryoablation, microwave ablation, laser-induced thermotherapy, and high-intensity focused ultrasound. RFA has recently gained interest and is the most widely applied thermoablative technique. RFA allows more effective tumor control in fewer treatment sessions compared with PEI, but with a higher rate of complications. However, there are certain circumstances where PEI therapy represents a better strategy to control liver tumors than RFA, especially in situations where RFA is difficult, for example when large vessels surround the tumor. In the context of hepatocellular carcinoma (HCC), both RFA and PEI are feasible and of benefit in non-operable patients. RFA seems superior to PEI in HCC > 2 cm, and the combination of interventions may be of benefit in selected patients. Liver resection is superior to RFA for patients with HCC meeting the Milan criteria, but RFA can be employed in tumors ≤ 3 cm and where there is an increased expected operative mortality. In addition, some lines of evidence indicate that RFA and PEI can be employed as a bridge to liver transplantation. The use of RFA in colorectal liver metastases is currently limited to unresectable disease and for patients unfit for surgery. The aim of this article is to summarize the current status of RFA in the management of liver tumors and compare it to the cheap and readily available technique of PEI.

CT-guided single high-dose percutaneous acetic acid injection for small hepatocellular carcinoma: A long-term follow-up study

To evaluate the long-term outcome of CT-guided single high-dose percutaneous acetic acid injection (PAI) for the treatment of small hepatocellular carcinoma (SHCC). Sixty-eight consecutive patients (37 men and 31 women; age 52 ± 16 years) with SHCC have undergone CT-guided single high-dose PAI therapy since December 2000. Complications of high-dose PAI were recorded. Tumour survival and recurrence rates were assessed. All PAI therapies were successful and no severe complications developed. The average follow-up period was 46 ± 18 months. The overall survival rates at 1, 2, 3, 4 and 5 years were 93%, 82%, 68%, 59% and 51%, respectively. The cumulative local recurrence rates for the main tumour at 1, 2, 3, 4 and 5 years were 18%, 22%, 25%, 28% and 28%, respectively. The cumulative new tumour recurrence rates at 1, 2, 3, 4 and 5 years were 24%, 40%, 43%, 60% and 62%, respectively. CT-guided single high-dose PAI is safe and effective for the treatment of SHCC after long-term follow-up.

Prognostic prediction across a gradient of total tumor volume in patients with hepatocellular carcinoma undergoing locoregional therapy

BackgroundThe size and number of tumors are important prognostic indicators for hepatocellular carcinoma (HCC). However, it is difficult to assess the prognosis for patients with a variable number and size of tumors. By combining these two factors, we investigated the role and prognostic accuracy of total tumor volume (TTV) for HCC.MethodsA total of 786 patients undergoing locoregional therapy (transarterial chemoembolization, percutaneous radiofrequency ablation and acetic acid or ethanol injection) for HCC were prospectively evaluated.ResultsThe mean and median TTV was 177 cm3 (range, 0.1-3,591 cm3) and 21 cm3, respectively. Of all, 38%, 29%, 15%, 7% and 11% of patients had TTV of <10 cm3, 10-50 cm3, 50-200 cm3, 200-500 cm3 and >500 cm3, respectively. TTV was significantly larger in patients with higher serum α-fetoprotein (AFP) levels or with vascular invasion. The Child-Turcotte-Pugh score, performance status, vascular invasion, AFP level and TTV were significant independent prognostic predictors in the Cox proportional hazards model. After adjustment, patients with TTV 50-200 cm3 (relative risk [RR]: 1.74, p = 0.009), 200-500 cm3 (RR: 2.15, p = 0.006) and >500 cm3 (RR: 3.92, p < 0.001) had a significantly increased mortality risk in comparison to patients with TTV <10 cm3.ConclusionsTTV is a feasible prognostic predictor across a wide gradient and can be used to predict the mortality risk of HCC. Selecting appropriate cutoffs of TTV may help refine the design of cancer staging system and treatment planning. Future clinical trials of HCC may include this parameter for mortality risk stratification.

Clinical outcomes of radiofrequency ablation, percutaneous alcohol and acetic acid injection for hepatocelullar carcinoma: A meta-analysis

Radiofrequency ablation (RFA) is often the preferred local ablation therapy for hepatocellular carcinoma (HCC). Percutaneous ethanol injection (PEI) is less frequently used, and percutaneous acetic acid injection (PAI) has been mostly abandoned. Robust evidence showing benefit of one therapy versus another is lacking. Our aim was to evaluate the evidence comparing RFA, PEI and PAI using meta-analytical techniques. Literature search was undertaken until December 2008 to identify comparative studies evaluating survival, recurrence, complete necrosis of tumour and complications. Only randomized clinical trials and quasi-randomized studies were included. Adjusted indirect comparisons were made when direct comparative studies were insufficient. Eight studies were identified: RFA vs. PEI (n=5), PAI vs. PEI (n=2) and RFA vs. PAI vs. PEI (n=1) including 1035 patients with nine comparisons. RFA was superior to PEI for survival (OR 0.52; 95% CI 0.35-0.78; p=0.001), complete necrosis of tumour and local recurrence. For tumours 2 cm RFA was not significantly better than PEI. PAI did not differ significantly from PEI for survival (OR 0.55; 95% CI 0.23-1.33; p=0.18), and local recurrence but required less sessions. PAI had similar outcomes, except local recurrence, to RFA in the direct and indirect comparison. RFA seems to be a superior ablative therapy than PEI for HCC, particularly for tumours >2 cm. PAI did not differ significantly from PEI for all the outcomes evaluated. RFA and PAI have similar survival rates. For tumours 2 cm outcome benefits comparing RFA and PEI are similar. PAI needs re-evaluation versus both PEI and RFA for tumours 2 cm.

1277: Sonographically Guided Percutaneous Interventional Therapies for 5-8 cm Noninfiltrating Hepatocellular Carcinoma: Long-term Therapeutic Efficacy Analysis

This study was To investigate the therapeutic efficacy on patients with 5-8 cm noninfiltrating hepatocellular carcinoma (HCC) treated with percutaneous ethanol injection (PEI), percutaneous acetic acid injection(PAI), percutaneous hot saline injection (PHSI), interstitial photodynamic therapy (IPDT),radiofrequency ablation (RFA), and combined interventional therapies (transcatheter arterial embolization plus PEI or RFA).

Image-guided Tumor Ablation: Standardization of Terminology and Reporting Criteria

The field of interventional oncology with use of image-guided tumor ablation requires standardization of terminology and reporting criteria to facilitate effective communication of ideas and appropriate comparison between treatments that use different technologies, such as chemical (ethanol or acetic acid) ablation, and thermal therapies, such as radiofrequency (RF), laser, microwave, ultrasound, and cryoablation. This document provides a framework that will hopefully facilitate the clearest communication between investigators and will provide the greatest flexibility in comparison between the many new, exciting, and emerging technologies. An appropriate vehicle for reporting the various aspects of image-guided ablation therapy, including classification of therapies and procedure terms, appropriate descriptors of imaging guidance, and terminology to define imaging and pathologic findings, are outlined. Methods for standardizing the reporting of follow-up findings and complications and other important aspects that require attention when reporting clinical results are addressed. It is the group's intention that adherence to the recommendations will facilitate achievement of the group's main objective: improved precision and communication in this field that lead to more accurate comparison of technologies and results and, ultimately, to improved patient outcomes. The intent of this standardization of terminology is to provide an appropriate vehicle for reporting the various aspects of image-guided ablation therapy.

(137) Percutaneous acetic acid injection in the treatment of hepatocellular carcinoma in cirrhotic patients

(137) Percutaneous acetic acid injection in the treatment of hepatocellular carcinoma in cirrhotic patients

Systematic meta-analysis on percutaneous ethanol injection and percutaneous acid injection for the treatment of early HCC: A Cochrane analysis

e15657 Background: Hepatocellular carcinoma (HCC) is the fifth most common global cancer with high geographical variability. When HCC is detected early, percutaneous approaches such as percutaneous ethanol injection (PEI), percutaneous acetic acid injection (PAI), and radiofrequency thermal ablation (RFTA) have curative potential and represent low invasive alternatives to surgery. The role of percutaneous ethanol or acetic acid injection and other percutaneous interventions except RFTA has not been addressed in a systematic metaanalysis. The objective was to evaluate the effects of PEI and PAI for early HCC. Methods: A systematic search was performed in EMBASE, Cochrane Central, The Cochrane Hepato-Biliary Group Controlled Trials Register, Medline and Scopus as well as a handsearch of meeting abstracts. Only randomised controlled trials were included. RFTA studies were not considered. Primary endpoint was overall survival, secondary endpoints were cancer free survival, number and type of adverse events, duration of hospital stay, and quality of life. Results: 3 studies covering 261 patients were identified. Two studies compared PEI with PAI. 91 and 94 patients with one to three HCC-nodules ≤ 3cm underwent PEI and PAI, respectively. Overall survival (HR 1.47; 95% CI 0.68 to 3.19) and cancer free survival (HR 1.42; 95% CI 0.68 to 2.94) were not significantly different after treatment by PEI versus PAI. Both treatments were safe with no serious adverse events reported and modest pain being the most frequent adverse event. Data on the duration of hospital stay were inconclusive and data on quality of life not available. One study compared PEI with surgery. 38 patients were allocated to each treatment arm. There was no significant difference in survival (HR 1.57; 95% CI 0.53 to 4.61) and cancer free survival (HR 1.35; 95% CI 0.69 to 2.63). No serious adverse events were reported in the PEI group but 3 postoperative deaths occurred in the surgery arm. Conclusions: PEI and PAI are similarly effective and safe in patients with one to three small (≤ 3 cm) HCC nodules. Although the evidence is weaker, the beneficial effect of PEI is comparable to that of segmental liver resection and thus should be used preferentially due to its low morbidity and mortality. No significant financial relationships to disclose.

Clinical trial: percutaneous acetic acid injection vs. percutaneous ethanol injection for small hepatocellular carcinoma – a long‐term follow‐up study

The long-term outcome of percutaneous acetic acid injection (PAI) and percutaneous ethanol injection (PEI) for treating small hepatocellular carcinoma (HCC) remains unclear. To compare the long-term outcome of PAI vs. PEI for treating small HCC. From July 1998 to July 2004, 125 patients with small HCC were enrolled. Seventy patients receiving PAI and 55 patients receiving PEI were enrolled. There were no significant differences in the clinical characteristics between the two groups. Tumour recurrence and survival rates were assessed. Mean follow-up time was 43 months. The local recurrence rate and new tumour recurrence rate were similar between the PAI and PEI groups. The PAI group had significantly better survival than the PEI group (P = 0.027). Multivariate analysis revealed that PAI was the significant factor associated with overall survival [PAI vs. PEI, RR: 0.639, 95% CI: (0.419-1.975), P = 0.038]. The treatment sessions required to achieve complete tumour necrosis were significantly fewer in the PAI group than in the PEI group (2.4 +/- 1.0 vs. 2.9 +/- 1.3, P = 0.018). Percutaneous acetic acid injection required fewer treatment sessions than PEI and provided better survival after long-term follow-up.