Computed Tomography Demonstration of Immediate and Delayed Complications of Computed Tomography–Guided Transthoracic Percutaneous Ethanol Injection of Hepatocellular Carcinoma at the Liver Dome

Tsai, Hann-Huei; Lin, Xi Zhang; Chen, Chiung Yu

doi:10.1097/00004728-200307000-00025

Cited by 8 publications

(2 citation statements)

References 13 publications

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“…Our results build on these studies by demonstrating that EC improves in vivo ethanol localization in tumors and slowed ethanol diffusion through tumor tissue, which may account for the increased safety and efficacy. Extratumoral leakage of ethanol out of hepatic [31] and thyroid [32,33] lesions after PEI was found to be proportional to the degree of clinical complications, supporting our findings that the addition of EC to the ethanol injectate increases safety. Finally, the addition of EC to PEI achieved comparable median and overall survival to repeat ethanol-only injections, making PEI with EC potentially feasible for more indications than previously explored.…”

Section: Discussionsupporting

confidence: 85%

Polymer-assisted intratumoral delivery of ethanol: Preclinical investigation of safety and efficacy in a murine breast cancer model

et al. 2021

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Focal tumor ablation with ethanol could provide benefits in low-resource settings because of its low overall cost, minimal imaging technology requirements, and acceptable clinical outcomes. Unfortunately, ethanol ablation is not commonly utilized because of a lack of predictability of the ablation zone, caused by inefficient retention of ethanol at the injection site. To create a predictable zone of ablation, we have developed a polymer-assisted ablation method using ethyl cellulose (EC) mixed with ethanol. EC is ethanol-soluble and water-insoluble, allowing for EC-ethanol to be injected as a liquid and precipitate into a solid, occluding the leakage of ethanol upon contact with tissue. The aims of this study were to compare the 1) safety, 2) release kinetics, 3) spatial distribution, 4) necrotic volume, and 5) overall survival of EC-ethanol to conventional ethanol ablation in a murine breast tumor model. Non-target tissue damage was monitored through localized adverse events recording, ethanol release kinetics with Raman spectroscopy, injectate distribution with in vivo imaging, target-tissue necrosis with NADH-diaphorase staining, and overall survival by proxy of tumor growth. EC-ethanol exhibited decreased localized adverse events, a slowing of the release rate of ethanol, more compact injection zones, 5-fold increase in target-tissue necrosis, and longer overall survival rates compared to the same volume of pure ethanol. A single 150 μL dose of 6% EC-ethanol achieved a similar survival probability rates to six daily 50 μL doses of pure ethanol used to simulate a slow-release of ethanol over 6 days. Taken together, these results demonstrate that EC-ethanol is safer and more effective than ethanol alone for ablating tumors.

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Section: Discussionsupporting

confidence: 85%

Polymer-assisted intratumoral delivery of ethanol: Preclinical investigation of safety and efficacy in a murine breast cancer model

et al. 2021

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“…With the current interventional techniques and operation facilities, the extrahepatic collateral arteries are often incompletely embolized, resulting in incomplete tumor necrosis. Although local ablation including percutaneous ethanol injection, radiofrequency ablation (RFA), and microwave ablation have been reported for the treatment of HCC of complex sites, many problems including complex procedures, serious complications, and low rates of complete ablation limit the application of local ablation (14)(15)(16)(17)(18).…”

Section: Introductionmentioning

confidence: 99%

Combined Ultrasound and CT-Guided Iodine-125 Seeds Implantation for Treatment of Residual Hepatocellular Carcinoma Located at Complex Sites After Transcatheter Arterial Chemoembolization

et al. 2021

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PurposeThe purpose of this study was to evaluate the efficacy and safety of iodine-125 (125I) seeds implantation under ultrasound and computed tomography (CT) guidance in the treatment of residual hepatocellular carcinoma (HCC) located at complex sites after transcatheter arterial chemoembolization (TACE).MethodsThis retrospective study analyzed the consecutive medical records of 31 HCC patients with residual tumors located at complex sites (such as large blood vessels, gallbladder, diaphragm dome, etc.) after TACE from May 2014 to December 2018, all of whom received 125I seeds implantation therapy. Overall survival (OS), progression-free survival (PFS), recurrence, and complications were documented.ResultsA total of 607 seeds were implanted in 31 patients, with an average of 19.6±10.4 (range, 8–48) seeds per patient. Median OS and PFS were 33 months (95% CI: 27.1 months, 38.9 months) and 15 months (95% CI: 9.6 months, 20.4 months), respectively. Although univariate analysis showed that albumin, prothrombin time, alpha-fetoprotein level, Child-Pugh score, and lipiodol deposition in tumor were associated with OS, multivariate analysis showed that none of them was an independent prognostic factor for OS. Multivariate analysis showed that prothrombin time was an independent prognostic factor for PFS. No operation-related deaths in this study. Although pneumothorax was present in two patients and subcutaneous abscess in one patient, symptoms improved in all three patients with appropriate treatment. Common minor complications included fever, abdominal pain and leukopenia and no grade≥3 adverse events were observed.Conclusions125I seeds implantation under the combined guidance of ultrasound and CT is safe and effective for patients with residual HCC located at complex sites after TACE. This is a promising treatment approach and deserves further discussion.

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Efficacy and safety of radiofrequency ablation of hepatocellular carcinoma in the hepatic dome with the CT-guided extrathoracic transhepatic approach

Kim

Lee

et al. 2006

European Journal of Radiology

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Computed Tomography Demonstration of Immediate and Delayed Complications of Computed Tomography–Guided Transthoracic Percutaneous Ethanol Injection of Hepatocellular Carcinoma at the Liver Dome

Abstract: Ethanol leakage is not uncommon when performing PEI; however, it seems to be safe when the leakage is less than 15 mL. Injection of a small amount of ethanol or monitoring by CT may be helpful in preventing the development of these complications.

Cited by 8 publications

References 13 publications

Polymer-assisted intratumoral delivery of ethanol: Preclinical investigation of safety and efficacy in a murine breast cancer model

Polymer-assisted intratumoral delivery of ethanol: Preclinical investigation of safety and efficacy in a murine breast cancer model

Combined Ultrasound and CT-Guided Iodine-125 Seeds Implantation for Treatment of Residual Hepatocellular Carcinoma Located at Complex Sites After Transcatheter Arterial Chemoembolization

Efficacy and safety of radiofrequency ablation of hepatocellular carcinoma in the hepatic dome with the CT-guided extrathoracic transhepatic approach

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