Long-term results of percutaneous ethanol injection therapy for hepatocellular carcinoma in cirrhosis: a European experience

Abstract

The objective of our work was to evaluate the long-term results of percutaneous ethanol injection (PEI) for the treatment of hepatocellular carcinoma (HCC) in patients with liver cirrhosis. A total of 184 cirrhotic patients with HCC underwent PEI as the only anticancer treatment over an 8-year period. Patients were followed after therapy by means of clinical examinations, laboratory tests, and US and CT studies performed at regular time intervals. Survival rates were determined according to the Kaplan-Meier method. The overall survival was 67% at 3 years, 41% at 5 years, and 19% at 7 years. The 3-, 5-, and 7-year survival rates of patients with single HCC < or = 3 cm (78, 54, and 28%, respectively) were significantly higher (p < 0.01) than those of patients with single HCC of 3.1-5 cm (61, 32, and 16, respectively) or multiple HCCs (51, 21, and 0%, respectively). Survival of Child-Pugh A patients (79% at 3 years, 53% at 5 years, and 32% at 7 years) was significantly longer (p < 0.01) than that of Child-Pugh B patients (50% at 3 years, 28% at 5 years, and 8% at 7 years). A selected group of 70 patients with Child-Pugh A cirrhosis and single HCC < or = 3 cm had a 7-year survival of 42%. Long-term survival of cirrhotic patients with HCC treated with PEI is comparable to that reported in published series of matched patients submitted to surgical resection.

Hepatocellular carcinoma screening in patients waiting for liver transplantation: A decision analytic model

“…For the referent strategy, CT is performed if AFP level is greater than 200 ng/mL. [34][35][36][37][38] In the U/S screening strategy, patients undergo CT if U/S suggests a mass. Screening with U/S and AFP level are performed in parallel with the U/S plus AFP strategy.…”

“…Screening with U/S and AFP level are performed in parallel with the U/S plus AFP strategy. If AFP level is greater than 200 ng/mL or U/S detects a suspicious mass, then patients undergo CT. [34][35][36][37][38] Patients undergo an abdominal computed tomographic scan for the CT strategy. Biopsies are performed on masses found by CT for any of these strategies.…”

Terpenoids as potential chemopreventive and therapeutic agents in liver cancer

“…Resection and transplantation achieve the best outcomes in well-selected candidates (5-year survival 60%-70%) [13][14][15][16] , and compete as the first option from an intention-to-treat perspective [17] . Percutaneous treatments provide good results (5-year survival 40%-50%) [11,18] , but have not been able to achieve response rates and outcomes comparable to surgical treatments [11,12] . Liver transplantation has been suggested as the best treatment for patients with one tumor and decompensated cirrhosis or multicentric small tumors [19] .…”

Percutaneous ethanol injection for ablation of hepatocellular carcinoma

“…It was shown that this modality does carry the risk of disseminating the tumor by facilitating the passage of malignant cells into the blood stream, but that was opposed by other authors, who consider that because ethanol diffuse along the needle tract, its cytotoxic effect and small vessel thrombosis minimize the risk seeding. 23 The most common side effect of alcohol injection is leakage of alcohol onto the surface of the liver and into the abdominal cavity, thereby causing pain and fever. It is important that the location of the tumor relative to the adjacent blood vessels and bile ducts is clearly identified.…”

“…23 The endpoint of local ablation is complete tumor necrosis with a margin of tissue. Of the methods of ablation, PEI and RFA are commonly performed and are effective as well.…”