Percutaneous Alcohol Injection Research Articles

Targeting the CSF1/CSF1R signaling pathway: an innovative strategy for ultrasound combined with macrophage exhaustion in pancreatic cancer therapy.

Pancreatic cancer (PC) is a highly aggressive and lethal malignancy characterized by a complex tumor microenvironment (TME) and immunosuppressive features that limit the efficacy of existing treatments. This paper reviews the potential of combining ultrasound with macrophage exhaustion in the treatment of pancreatic cancer. Macrophages, particularly tumor-associated macrophages (TAMs), are crucial in pancreatic cancer progression and immune escape. Prolonged exposure to the immunosuppressive TME leads to macrophage exhaustion, reducing their anti-tumor ability and instead promoting tumor growth. The CSF1/CSF1R signaling pathway is key in macrophage recruitment and functional regulation, making it an effective target for combating macrophage exhaustion. Ultrasound technology not only plays a significant role in diagnosis and staging but also enhances therapeutic efficacy by guiding radiofrequency ablation (RFA) and percutaneous alcohol injection (PEI) in combination with immunomodulators. Additionally, ultrasound imaging can monitor the number and functional status of TAMs in real-time, providing a basis for optimizing treatment strategies. Future studies should further investigate the combined use of ultrasound and immunomodulators to refine treatment regimens, address challenges such as individual variability and long-term effects, and offer new hope for pancreatic cancer patients.

Non-Thermal Liver Ablation: Existing and New Technology.

Cancer has and continues to be a complex health crisis plaguing millions around the world. Alcohol ablation was one of the initial methods used for the treatment of liver lesions. It was surpassed by thermal ablation which has played a big role in the therapeutic arsenal for primary and metastatic liver tumors. However, thermal ablation has several shortcomings and limitations that prompted the development of alternative technologies including electroporation and histotripsy. Percutaneous alcohol injection in the liver lesion leads to dehydration and coagulative necrosis. This technology is limited to the lesion with relative sparing of the surrounding tissue, making it safe to use adjacent to sensitive structures. Electroporation utilizes short high-voltage pulses to permeabilize the cell membrane and can result in cell death dependent on the threshold reached. It can effectively target the tumor margins and has lower damage rates to surrounding structures due to the short pulse duration. Histotripsy is a novel technology, and although the first human trial was just completed, its results are encouraging, given the sharp demarcation of the targeted tissue, lack of thermal damage, and potential for immunomodulation of the tumor microenvironment. Herein, we discuss these techniques, their uses, and overall clinical benefit.

Non-Surgical Locoregional Therapies Alone or in Combination with Systemic Therapy in Patients with Hepatocellular Carcinoma.

Hepatocellular carcinoma (HCC) is the most common primary liver cancer, representing the third-leading cause of cancer-related deaths worldwide. Curative intent treatment options for patients with HCC include liver transplantation, resection and ablation of small lesions. Other potentially curative therapies include cryoablation, microwave ablation and percutaneous alcohol injection. For locally advanced disease, different arterially directed therapies including transarterial chemoembolization and selective internal radiation therapy, plus external beam radiation including three-dimensional conformal radiation therapy, intensity-modulated radiation therapy, stereotactic body radiation therapy and proton beam therapy, are available or studied. Systemic therapies based on checkpoint inhibitors and tyrosine kinase inhibitors are available for the management of metastatic HCC and sometimes for locally advanced disease. Combinations of locoregional therapies with systemic drugs are currently the subject of several clinical trials.

Safety of Ultrasound-Guided Percutaneous Injection of Alcohol as a Scolicidal Agent for the Treatment of Liver Hydatid Cysts

Background: Hydatid disease is a health problem in the developing world. Percutaneous therapy with various scolicidal agents has been described; however, there is a paucity of literature on the use of absolute alcohol injection without reaspiration as a sole scolicidal agent. The study carried out in a tertiary hospital aimed to prospectively evaluate the safety and outcomes of ultrasound-guided percutaneous injection of alcohol for liver hydatid cyst. Methodology: Consecutive patients with liver hydatid cysts were evaluated with ultrasound, classified according to the WHO classification between June 2012 and January 2020. Eligible patients underwent ultrasound-guided percutaneous therapy after three courses of oral albendazole. Patients having elevated cyst fluid bilirubin levels were excluded. Patients who underwent percutaneous alcohol injection were followed up clinically and with imaging. Data were entered in Microsoft Excel spreadsheet and analyzed. Results: Fifty-two consecutive patients with hydatid cyst were evaluated during the study. Among these, 27 patients underwent percutaneous alcohol injection. Follow-up data were available for 25 patients. There was a favorable imaging outcome in 21/25 (84%). One patient developed anaphylaxis during cyst access, which was managed medically with an uneventful recovery. No instances of cholangitis or sepsis following injection were observed. Conclusion: Percutaneous alcohol injection therapy for liver hydatid cysts is a minimally invasive, safe, and an effective procedure in selected group of patients.

Percutaneous vertebroplasty for the treatment of symptomatic vertebral hemangioma with long-term follow-up

There is a paucity of literature on vertebroplasty in hemangioma. The effectiveness with short-term and long-term follow-up is an important insight for research. This study aims to evaluate the effectiveness and the long-term efficacy of vertebroplasty in the treatment of the patient with symptomatic vertebral hemangioma. Materials and methodsThis is a retrospective cohort study. The outcome was evaluated by immediate post-procedure and 3 months, 1 year, and 5 years of follow-up clinical status of the patients. The significance was determined by using a paired t-test between the pre-procedure and post-procedure severity of pain, activity score, and analgesic. The P-value < 0.05 indicated statistical significance. ResultsA total of 38 vertebroplasties were performed in 34 patients. Additionally, the embolization of residual soft tissue was performed in 4 patient and Percutaneous alcohol injection for posterior elements involvement was performed in 9 patients. Immediate after the procedure, 44.12% of patients became asymptomatic, 38.23% of patients showed significant improvement, 11.77% of patients remained static and 2.94% of patients deteriorated and needed laminectomy. The complication rate was 29.4%, but only 2 patients were symptomatic and needed surgical decompression. There was significant relief of pain (P < 0.05), reduced analgesic intake (P < 0.05), and increased activity (P < 0.05) immediately after the procedure, 3 months, 1 year, and 5 years follow-up. ConclusionPVP is an effective therapeutic option for the treatment of VH with fewer complications. The additional procedures like preprocedural embolization and percutaneous alcohol injection enhance the outcome and avoid complicated surgical interventions.

Transplantation After Successful Downstaging by Multimodal Treatments of American Joint Committee on Cancer Stage IIIB Hepatocellular Carcinoma With Portal Vein Thrombi: A Case Report

The effective treatment for hepatocellular carcinoma (HCC) with American Joint Committee on Cancer stage IIIB remains controversial and challenging because of the high recurrence rate after resection and low survival rate. The median survival of those with macroscopic portal vein tumor thrombus (PVTT) is short. We reported such a case which received liver transplantation (LT) after successful consecutive downstaging therapies. A 40-year-old man with alcohol related liver cirrhosis and repeated esophageal varices bleeding had HCC with tumor thrombi in right main portal vein and the second portal branch of segment VI (stage IIIB). The received percutaneous alcohol injection, radiofrequency ablation, 8 sessions of transcatheter hepatic arterial chemoembolization, radiotherapy, and target therapy with sorafenib. Computed tomography (CT) scan and magnetic resonance imaging after treatments showed no viable fragments in the tumor and revealed both the right main portal vein and V1 branch were patent. One month later, the patient received a deceased LT. The perioperative course was rather smooth. After discharge, the interval follow-up CT studies of the chest and liver and whole body bone scan showed no tumor recurrence or metastasis up to 20 months postoperation.

3:50 PM Abstract No. 395 Comparison of alcohol ablation and radiofrequency ablation for treatment of hepatocellular carcinoma: A retrospective analysis of long-term overall and disease-free survival

To compare overall survival (OS) and disease-free survival (DFS) following percutaneous alcohol injection (PEI) and radiofrequency ablation (RFA) for the treatment of hepatocellular carcinoma. This is a single-institution retrospective cohort study. Patients who underwent PEI or RFA between 2005 and 2009 for hepatocellular carcinoma without extrahepatic metastases were included in this analysis. Patient data was collected between the time of procedure to September 1, 2017. A chart review was performed for baseline characteristics, clinical success, complications, survival, disease recurrence, additional treatment, and transplant. Statistical analysis was performed using SPSS (IBM, New York). 126 patients are included in this analysis. 56 patients were treated with PEI and 70 patients with RFA. The RFA group had a significantly higher proportion of patients with Child Pugh A liver cirrhosis and tumors <3 cm. Technical success was 95% and 98% for PEI and RFA, respectively. Complication rates for PEI and RFA were 11% and 9%, respectively. OS and DFS are summarized in Table 1. Patients in the RFA group had significantly higher OS at 2, 3, 4, and 5 years. Between 6 and 9 years there was no significant difference in OS between the two groups. Differences in DFS between PEI and RFA at all time points did not reach statistical significance. Analysis limited to patients with tumors <3 cm demonstrated significantly higher OS in patients treated with RFA only at 1 and 5 years. The remaining time points showed no significant difference between the two groups. Similarly, analysis limited to patients with Child Pugh A liver cirrhosis showed significantly higher OS in the RFA group only at 3 and 4 years. PEI and RFA have comparable DFS and long-term OS in patients with small hepatomas and good liver status based on Child-Pugh score.Table 1YearPEI OS (%)RFA OS (%)PPEI DFS (%)RFA DFS (%)P179870.352570.5245710.0129410.2335560.0129290.6431530.0123270.3523430.0121230.4623360.0721200.5723340.121200.6823310.221170.8920280.120160.7 Open table in a new tab

Sclerotherapy using Surgiflo and alcohol: a new alternative for the treatment of aneurysmal bone cysts.

PurposeThis study aims to review the results of sclerotherapy using Surgiflo in addition to alcohol in primary aneurysmal bone cysts (ABC).MethodsA total of 16 consecutive patients with histologically confirmed diagnosis of primary ABC were treated by percutaneous Surgiflo and alcohol injection at our institution. Clinical follow-up included the assessment of pain, swelling, limping and functional impairment. Radiological parameters included tumour volume, physis-cyst distance, thickness of cyst cortex, and presence of intracystic septations. Mean follow-up was 35,6 months (24–71 months). Treatment was considered successful when the cyst volume decreased by a minimum of 10%, the bone cortex became thicker, and the distance to physis increased.ResultsMean age at presentation was 9.5 years (5.16–13.84 years). All ABC’s were primary and all patients underwent a single Surgiflo and alcohol session except for two (12.5%) who required a second session. All patients had a good clinical result at final follow-up. Satisfactory cyst healing was achieved in 11 cases according to radiological parameters. Tumour volume decreased from a mean of 122 cm3 (111 to 133) before injection to 86 cm3 (76 to 96) at last follow-up (p < 0.01). Physis-cyst distance increased from a mean of 1 cm (0.1 to 2) to 2.1 cm (0.5 to 4) at last follow-up (p < 0.01). Cortical thickness improved from 1 mm (0.5 to 1.5) to 2 mm (1 to 3.5) at last follow-up (p < 0.01).There were no treatment related complications. Surgery was performed in one patient having a C3 vertebra ABC after developing quadriparesis due to tumour progression.ConclusionSclerotherapy using Surgiflo and alcohol may be used as an efficient, safe and minimally invasive alternative for the treatment of primary ABCs.

PRIMARY EXPERIENCE WITH CT GUIDED MANDIBULAR NERVE BLOCK IN PATIENTS WITH TRIGEMINAL NEURALGIA

Background: Trigeminal neuralgia (TN) is a well-known facial pain syndrome characterized by excruciating paroxysmal shock pain attacks located in somato-sensensory distribution of trigeminal nerve. Mandibular affection is a common presentation of TN. Objectives: Studying the effect of injection of mandibular nerve with neurolytic solutions in trigeminal neuralgia that was unresponsive to pharmacotherapy. Patients and Method: This prospective study included 21 patients treated for mandibular neuralgia by percutaneous injection of absolute alcohol under guidance of CT image. Their ages ranged from 35-60 years and male to female was 3:4. All patients suffered from moderate to severe TN, and did not respond to medical treatment. Entry and trajectory of needle was planned by CT and after local anesthesia. Alcohol was injected at the exit of mandibular nerve from foramen ovale. Results: 85.7% of patients improved (71.4% became pain free and severity of pain decreased in 19%), while 9.6% of patients has no response after injection. The pain free patients became 61.9% after two years of follow up. Conclusion: CT guided mandibular nerve block by neurolytic agent as absolute alcohol and showed its effectiveness as minimal invasive treatment option for intractable trigeminal neuralgia. CT guidance provided a clear view to secure the safety, accuracy and selectivity of nerve block.

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.

Doxorubicin-eluting beads versus combined conventional transarterial chemoembolization and percutaneous alcohol injection in the treatment of large hepatocellular carcinoma

Introduction Hepatocellular carcinoma (HCC) is a primary tumor of the liver, which usually develops in the setting of chronic liver disease, particularly in patients with chronic hepatitis B and hepatitis C. Current guidelines recommend transarterial chemoembolization (TACE) as the standard treatment of Barcelona Clinic Liver Cancer-B patients. The aim of this work is to compare the efficacy, safety, feasibility, and cost-effectiveness of drug-eluting bead (DEB)-TACE versus combined conventional transarterial chemoembolization (c-TACE)+percutaneous ethanol injection (PEI) for improving the outcome of large HCC. Patients and methods In all, 75 patients with large HCC were included in this study: 30 patients were treated by combined c-TACE + PEI and 45 patients were treated by DEB-TACE. Results By comparison of the results of the combined c-TACE + PEI group with the DEB-TACE group, there was no significant difference in tumor response, with better results in the combined c-TACE + PEI group and significant decrease in the median value of the serum level of α-fetoprotein after treatment among patients treated with combined c-TACE + PEI (P = 0.004), and a statistically significant difference in the median value after treatment between the two groups (P = 0.036). Conclusion Results of combined c-TACE + PEI and DEB-TACE are comparable, but the cost of a DEB-TACE session is three times that of c-TACE + PEI, and thus cost-effectiveness analyses recommend the use of combined c-TACE + PEI (less cost) in the treatment of large HCC; in addition, there was a significant reduction in the level of α-fetoprotein after combined c-TACE+PEI treatment.

Percutaneous alcohol injection under sonographic guidance in Morton's neuroma: follow-up in 220 treated lesions.

To evaluate the efficacy and safety of percutaneous treatment of Civinini-Morton's syndrome due to solitary Morton's neuroma and analyze the effect of clinico-demographic factors on outcome. Alcohol injection was performed under sonographic guidance in 220 consecutive patients. Pain intensity using a numerical rating scale (NRS), pain features, limitation of everyday activities and comorbidity with other forefoot conditions were evaluated at presentation. Patients were reassessed for symptoms and the need of rescue therapy with neurectomy after a mean follow-up of 19.0months (range 15-24). We treated 220 patients (33 males, mean age 55.8years). Neuromas were located in the III intermetatarsal space in 85.5%, with a mean size of 5.4mm. When considering a reduction of pain intensity of≥50% of NRS or a complete disappearance of the neuropathic features as a satisfactory clinical response, a 72.3% (p<0.001) responder rate was obtained, and only three patients relapsed (1.2%). An improvement in limitation of everyday activities was observed in 88.6% (p<0.001). No influence of clinico-demographic variables on outcome was found. No major complications occurred. Patients with unsatisfactory response had an overload-related comorbid condition in 20/61 (32.8%). Surgery was later performed in 14 non-responder patients. Ultrasound-guided alcoholization demonstrated a safe profile, relieved neuropathic symptoms in a majority of patients and improved their quality of life. Rescue therapy with surgery is feasible in patients with unsatisfactory response. However, a thorough evaluation for forefoot comorbidities should be obtained, as they may act as confounding factors.

Surgery for early stage hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related death worldwide, and the curative treatment is available only for tumors detected in early stage. In a critical analysis of the therapeutic options in early stage HCC three potential curatives therapies are possible in early stage HCC: total hepatectomy with liver transplantation (LT), partial hepatectomy and radiofrequency ablation (RFA) of very small tumors. Total hepatectomy with LT has proven to be the best treatment for operable and resectable disease (BCLC 0 and A) in a cirrhotic liver, the liver resection, RFA, transarterial chemoembolization (TACE) or percutaneous injection of alcohol (PIA) can be considered for those patients with waiting list time up to six months. Partial hepatectomy as definitive therapy should be used only for patients with patients in Child-Pugh A and B without portal hypertension. In patients with inoperable but localized disease (BCLC A), the RFA or PIA can be indicated.

Ethanol sclerotherapy of head and neck venous malformations.

ABSTRACTObjective:This retrospective study evaluated the results of sclerotherapy with low doses of ethanol for treatment of head and neck venous malformations.Methods:We treated 51 patients, 37 females. Median age was 23 years. Patients were treated with percutaneous intralesional injection of alcohol every two weeks and followed up prospectively for a median period of 18 months. Most lesions affected the face and cosmetic disfigurement was the most frequent complaint.Results:We performed a median of 7 sessions of sclerotherapy. Complete resolution or improvement was observed in 48 patients presented. Five cases of small skin ulceration, two cases of hyperpigmentation and two of paresthesia were documented; all of them were treated conservatively.Conclusion:Percutaneous sclerotherapy with low doses of ethanol is a safe and effective treatment modality for venous malformations affecting the head and neck.

Comparison of High-intensity Focused Ultrasound with Percutaneous Anhydrous Alcohol Locally Injection Guided by Ultrasound on Curing Portal Vein Tumor Thrombosis

Objective To compare the efficacy and side effects of high-intensity focused ultrasound(HIFU) with anhydrous alcohol injection guided by ultrasound on patients with portal vein tumor thrombosis(PVTT).Methods 86 patients with primary liver cancer(PLC) combined with PVTT in our hospital were retrospectively analyzed.Liver lesions were basically treated with transcatheter arterial chemoembolization(TACE),and HIFU or percutaneous anhydrous alcohol injection were sued as complimentary treatment to 52 cases(group A) and 34 cases(group B),respectively.Response rate(RR),clinical beneficial response(CBR),overall survival(OS) and side effects were evaluated between two groups.Results RR in group A and B were 40.38% vs.41.18%(P=0.1493),CBR were 48.08% vs.23.53%(P=0.0102),median OS were 12.3 months(range:3.6~23.5) vs.11.5 months(range: 4.2~21.3)(P=0.1504).Main side effects occurred in group A was upper gastrointestinal(GI) hemorrhage and liver area pain,while fever and hemorrhage under liver capsule occurred in group B.The occurance rates of side effects in group B were much higher than those in group A(P=0.0051).Conclusion HIFU and percutaneous anhydrous alcohol injection guided by ultrasound are both safe and effective approaches for therapy of PVTT.The short-term and long-term response was similar in two groups,while HIFU was superior to anhydrous alcohol injection on CBR and side effects.HIFU maybe a good choice patients with disordered liver function,ascites and intolerable to other methods.

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.

Transarterial Chemoembolization for Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is the fifth most common malignancy in the world and is responsible for ~500,000 deaths worldwide annually.1 The incidence almost equals the mortality. It is the most common cause of death in patients with compensated liver cirrhosis. HCC usually arises in the setting of chronic liver disease, commonly from hepatitis B, C, or alcohol abuse. In fact, 80% of HCC arises in the setting of cirrhosis. Despite available treatment, survival rates of HCC remain poor, with an estimation of 54% at 1 year, 40% at 2 years, and 28% at 3 years.2 The only definitive therapy is liver transplantation. Resection, when possible, is not curative as cirrhosis remains a comorbidity. Even with transplantation in early HCC associated with cirrhosis, there is still a potential risk for HCC recurrence.3 Typically, transplantation is reserved for candidates with a single lesion up to 5 cm in diameter, or multiple lesions up to three with a total diameter of 9 cm, with no vascular invasion and no regional or distant nodal metastatic disease. The 4-year survival rate for transplantation is ~80%. Similar survival rates have been reported for larger HCCs.4 With transplantation the only curative option, qualified patients often languish on the waiting list due to the current organ shortage. It has been shown that a 6- to 12-month waiting time for orthotopic liver transplantation (OLT) is associated with reduced overall survival compared with subjects with lesser waiting time due to progression of tumor beyond favorable criteria or due to drop-out for other reasons.5 In fact, the average waiting time can exceed one-year, at which point the drop-out rate is 30 to 40%. Drop-out rate from HCC progression beyond favorable criteria is estimated at 10% at 6 months.6 Surgical resection can increase the OLT rate to 3.7% and 10.7% for a waiting list of 6 and 24 months, respectively. However, surgical resection is associated with significant risks in the setting of cirrhosis, including hemorrhage and hepatic decompensation.7 It is in this setting that other therapies have been developed to treat, though not necessarily cure, patients with HCC to prevent HCC progression and increase the chance of organ transplantation, to downstage patients into favorable criteria for liver transplantation, and to prolong survival and improve quality of life for those who do not qualify for liver transplantation. Therapies that have been in use include transarterial chemoembolization (TACE), ablative therapies (including both thermal and cryoablation), radio embolization, and percutaneous alcohol injection. The focus of this article is on the rationale, technique, and results of TACE in HCC in the setting of cirrhosis.

Bilateral Trapped Lung with Concomitant Wermer's Syndrome and Cutis Laxa

We report a rare occurrence of trapped lung associated with Wermer's syndrome and cutis laxa. A 25-year-old man with bilateral trapped lung presented with respiratory distress. Additional investigation revealed adenoma of the parathyroid and hypophysis, a neuroendocrine abdominal tumor, and cutis laxa. Successful treatment of the respiratory symptoms was achieved through a median sternotomy with bilateral decortication, and excision of the bilateral fibrous pleural bands and bullae on the right upper lobe. Octreotide therapy was initiated and a percutaneous ultrasound-guided alcohol injection to the parathyroid adenoma was done. The patient has gynecomastia, acromegaly, and kyphoscoliosis. The patient remains well at 19 months after treatment.

P37.05: Treatment of TRAP sequence by percutaneous injection of absolute alcohol into the umbilical artery: A case report

P37.05: Treatment of TRAP sequence by percutaneous injection of absolute alcohol into the umbilical artery: A case report

Ethanol injection under ultrasound guidance to palliate unresectable parathyroid carcinoma

Severe hypercalcemia is the leading cause of death in patients with parathyroid carcinoma. Non-curative resection and pharmacological measures may be useful for palliation in cases with recurrent and metastatic disease. Palliative treatment with intra-neoplastic ethanol injection has not been reported yet. Ultrasound-guided percutaneous alcohol injection in one patient with unresectable parathyroid carcinoma is reported. One male patient with extensive recurrent parathyroid carcinoma suffering from severe hypercalcemia, refractory to all available medical measures has undergone two percutaneous ethanol injections. No major complications ensued and parathormone levels decreased from 2.990 pg/mL to 2.230 pg/ml after the first injection, and to 1.104 pg/mL after the second one. Calcium levels decreased from 19.8 mg/dL to 16.1 mg/dL and to 14.5 mg/dL, respectively. The patient died of metabolic hypercalcemia complications about two months later, probably due to mediastinal disease progression. Ultrasound-guided percutaneous ethanol injection may be employed to palliate parathyroid carcinoma in selected cases, with a transitory decrease in PTH and calcium levels.