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Long term results of single session percutaneous ethanol injection in patients with large hepatocellular carcinoma
Author(s) -
Livraghi Tito,
Benedini Viviano,
Lazzaroni Sergio,
Meloni Franca,
Torzilli Guido,
Vettori Claudio
Publication year - 1998
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/(sici)1097-0142(19980701)83:1<48::aid-cncr7>3.0.co;2-a
Subject(s) - medicine , hepatocellular carcinoma , percutaneous ethanol injection , cirrhosis , single center , percutaneous , gastroenterology , surgery , esophageal varices , survival rate , group b , group a , portal hypertension , radiofrequency ablation , ablation
BACKGROUND The objective of this study was to evaluate the indications for percutaneous ethanol injection (PEI) performed in a single session under general anesthesia for treating patients with cirrhosis and large (tumors > 5 cm) hepatocellular carcinoma (HCC), and relevant survival curves. METHODS Between November 1991 and November 1996, 108 patients were treated (a total of 128 procedures). They fell into 3 groups: 24 patients with single, encapsulated HCC measuring from 5‐8.5 cm (Group A); 63 patients with single, infiltrating HCC measuring from 5‐10 cm or multiple HCC (Group B); and 21 patients with advanced disease, either hepatic (Child's Class C) or neoplastic (symptomatic HCC or with portal thrombosis) type (Group C). The mean amount of ethanol injected was 62 mL. The average hospital stay was 3.8 days. The mean follow‐up time was 40 months. RESULTS The 1‐, 2‐, 3‐, and 4‐year survival rates were: 72%, 65%, 57%, and 44%, respectively, for Group A; 73%, 60%, 42%, and 18%, respectively, for Group B; and 46%, 25%, and 0%, respectively, for Group C. Mortality was 0.7% (bleeding from esophageal varices in a Child's Class C patient). The rate of major complications was 4.6% (1 case of peritoneal hemorrhage, 1 case of severe liver failure, 1 case of transient renal insufficiency, 1 case of peritoneal seeding, and 2 cases of infarctions of a segment adjacent to the tumor). CONCLUSIONS Single session PEI has been proven to be a valid alternative in patients otherwise treated surgically or with transcatheter arterial chemoembolization who present with adverse prognostic factors or risks for these therapies, and may be an option for selected patients with advanced disease previously excluded from any therapy. Risk conditions are marked portal or pulmonary hypertension or esophageal varices at risk of bleeding, superficial tumors with severe coagulation disorders, hyperfibrinolysis, chronic renal insufficiency, and obstructive jaundice. Cancer 1998;83:48‐57. © 1998 American Cancer Society.