Local recurrence of hepatocellular carcinoma after percutaneous ethanol injection

Ishii, Hiroshi; Okada, Shuichi; Nose, Haruhiko; Okusaka, Takuji; Yoshimori, Masayoshi; Takayama, Tadatoshi; Kosuge, Tomoo; Yamasaki, Susumu; Sakamoto, Michiie; Hirohashi, Setsuo

doi:10.1002/(sici)1097-0142(19960501)77:9<1792::aid-cncr6>3.0.co;2-e

Cited by 173 publications

(101 citation statements)

References 15 publications

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“…36 In fact, its use with HCC nodules smaller than 2.0 cm in diameter was associated with a local recurrence rate of approximately 10%. 6,37 This rate of failures associated with PEI is probably related to limited operator skill, difficult tumor sites, and above all tissue characteristics (septa, capsular microinfiltration) that impede uniform diffusion of the injected ethanol. 38 In recent years, RFA has surpassed PEI in terms of the local tumor control it offers 8,9 and for overall patient survival.…”

Section: Discussionmentioning

confidence: 99%

Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: Is resection still the treatment of choice?

et al. 2007

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If liver transplantation is not feasible, partial resection is considered the treatment of choice for hepatocellular carcinoma (HCC) in patients with cirrhosis. However, in some centers the firstline treatment for small, single, operable HCC is now radiofrequency ablation (RFA). In the current study, 218 patients with single HCC < 2.0 cm (very early or T1 stage) underwent RFA. We assessed 2 primary end points that could be easily compared with those reported for resective surgery: (1) the rate of sustained, local, complete response and (2) the rate of treatment-related complications. The secondary end point was 5-year survival in the 100 patients whose tumors had been considered potentially operable. After a median follow-up of 31 months, sustained complete response was observed in 216 patients (97.2%). In the remaining 6, percutaneous ethanol injection, selective intraarterial chemoembolization, or resection were used as salvage therapy. Perioperative mortality, major complication, and 5-year survival rates were 0%, 1.8%, and 68.5%, respectively. Conclusion: Compared with resection, RFA is less invasive and associated with lower complication rate and lower costs. RFA is also just as effective for ensuring local control of stage T1 HCC, and it is associated with similar survival rates (as recently demonstrated by 2 randomized trials). These data indicate that RFA can be considered the treatment of choice for patients with single HCC < 2.0 cm, even when surgical resection is possible. Other approaches can be used as salvage therapy for the few cases in which RFA is unsuccessful or unfeasible. ( on the oncological assumption that resection is the more suitable option for obtaining the complete tumor ablation including a layer of tissue surrounding it. 2,3 The importance of the local complete response (in other words, the absence of residual neoplastic tissue at the site of the tumor) on the overall survival in patients with HCC had been proved not only for surgery but also for percutaneous ablation therapies (PATs). 4,5 PATs were originally reserved for HCCs that were, for one reason or another, unsuitable for resective surgery, but they are now proving their worth in small operable cases as well. 6,7 Radiofrequency ablation (RFA) is currently considered the most effective PAT, [8][9][10][11] and 2 recent randomized trials failed to reveal significant differences between the survival rates associated with resective surgery and RFA in patients with early HCC. 12,13 These considerations have led some centers to adopt RFA as first-line treatment for single HCC nodules less than 3.0 cm in diameter, [14][15][16][17] opening the debate over the best therapeutic option for these small tumors.To clarify this issue, we conducted a multicenter study that included a consecutive series of patients with single HCC 2.0 cm or less in diameter accompanying cirrhosis

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Section: Discussionmentioning

confidence: 99%

Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: Is resection still the treatment of choice?

et al. 2007

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“…Survival rates of patients treated with percutaneous ethanol injection have been reported to be 38-60% at 5 years [287][288][289][290]. Local tumor progression rates after percutaneous ethanol injection have been reported to be 6-31% depending on the size of tumor [288,289,291,292]. Percutaneous ethanol injection has been considered a safe procedure, with mortality and morbidity rates of 0-3.2% and 0-0.4%, respectively [289,291,293].…”

Section: Local Ablation Is a First-line Treatment Of Unresectable Smmentioning

confidence: 99%

Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

et al. 2010

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Introduction The Asian Pacific Association for the Study of the Liver (APASL) convened an international working party on the management of hepatocellular carcinoma (HCC) in December 2008 to develop consensus recommendations. Methods The working party consisted of expert hepatologist, hepatobiliary surgeon, radiologist, and oncologist from Asian-Pacific region, who were requested to make drafts prior to the consensus meeting held at Bali, Indonesia on 4 December 2008. The quality of existing evidence and strength of recommendations were ranked from 1 (highest) to 5 (lowest) and from A (strongest) to D (weakest), respectively, according to the Oxford system of evidence-based approach for developing the consensus statements. 123Hepatol Int (2010) 4: 439-474 DOI 10.1007/s12072-010-9165-7 Results Participants of the consensus meeting assessed the quality of cited studies and assigned grades to the recommendation statements. Finalized recommendations were presented at the fourth APASL single topic conference on viral-related HCC at Bali, Indonesia and approved by the participants of the conference.

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“…Comparison of the efficacy of RFA with other local therapies showed that RFA was substantially superior to PEI, especially in tumors with a diameter > 2 cm [38,39] . Nevertheless, PEI is associated with a necrosis rate of 90%-100% in tumors < 2 cm and is still useful in selected patients when RFA is not technically feasible [40][41][42] . Recently, it was reported that in cases where the tumor is located under the diaphragm or near the surface of the liver, creating artificial ascites or pleural effusion is helpful in performing RFA and avoiding burns on adjacent organs [43,44] .…”

Section: Interventional Therapiesmentioning

confidence: 99%

Current management of hepatocellular carcinoma: An Eastern perspective

Yim¹

2015

WJG

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Local recurrence of hepatocellular carcinoma after percutaneous ethanol injection

Abstract: This study demonstrated that tumor size influences the local efficacy of PEI for small HCC. Therefore, we recommend that a reasonable indication for PEI therapy is HCC lesions measuring less than 30 mm in greatest dimension.

Cited by 173 publications

References 15 publications

Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: Is resection still the treatment of choice?

Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: Is resection still the treatment of choice?

Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

Current management of hepatocellular carcinoma: An Eastern perspective

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