Percutaneous ethanol injection for small hepatocellular carcinoma: Therapeutic efficacy based on 20-year observation

Ebara, Masaaki; Okabe, Shinichiro; Kita, K; Sugiura, Norío; Fukuda, Hiroyuki; Yoshikawa, Masaharu; Kondo, Fukuo; Saisho, Hiromitsu

doi:10.1016/j.jhep.2005.03.033

Cited by 183 publications

(123 citation statements)

References 28 publications

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“…Previous studies have reported intra-hepatic distant recurrence rates of 18.7-22.5%, 62.1-67% and 81-81.7% at 1, 3 and 5 years, respectively, after percutaneous ethanol injection therapy (PEIT) (31-33), 38 and 60% at 1 and 2 years, respectively, after RFA (34), and 18 and 52% at 1 and 2 years, respectively, after RFA or microwave coagulation therapy (35). In the present subjects, distant recurrence occurred in 8.3, 19.3 and 66.3% at 1, 3 and 5 years, respectively, after the combination of TACE and RFA; these rates were comparable to those reported previously (31)(32)(33)(34)(35). The recurrences of HCC decrease liver function and worsen prognosis.…”

Section: Discussionsupporting

confidence: 88%

Clinical significance of tumor markers in detection of recurrent hepatocellular carcinoma after radiofrequency ablation

Beppu

Sugimoto²,

Shiraki³

et al. 2010

Int J Mol Med

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Abstract. The aim of this study was to elucidate the importance of three tumor markers, ·-fetoprotein (AFP), Lens culinaris agglutinin A-reactive fraction of AFP (AFP-L3), and des-Á-carboxy prothrombin (DCP), for detecting and predicting the recurrence of hepatocellular carcinomas (HCCs). A total of 108 patients with initial non-advanced HCC who underwent curative radiofrequency ablation (RFA) in our hospital were enrolled in this study. The effectiveness of the three tumor markers for detecting recurrence and recurrence-free survival was analyzed. Positivity of these three makers was not markedly increased at the first or second recurrence. In addition, there was no significant correlation between the initial and recurrent levels of each tumor marker. The tumor marker that was positive at the time of initial HCC was not necessarily positive at recurrence. The tumor marker levels at recurrence were not correlated with pre-ablation levels. No significant correlation was found in the tumor marker values between pre-ablation and the time of recurrence. On multivariate analysis, high AFP-L3 levels (≥10%) were significantly predictive of recurrence-free survival. All three tumor markers should be routinely measured to detect recurrence during follow-up after RFA. Especially high AFP-L3 levels should be followed closely.

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Section: Discussionsupporting

confidence: 88%

Clinical significance of tumor markers in detection of recurrent hepatocellular carcinoma after radiofrequency ablation

Beppu

Sugimoto²,

Shiraki³

et al. 2010

Int J Mol Med

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“…The exclusion criteria were: (1) poor or absent visualization of the nodule on ultrasound (US); (2) intestinal loops or main bile ducts adjacent to the tumor, because this presentation is considered a relative contraindication for RFA; (3) severe coagulation disorders (prothrombin activity Ͻ 40% or platelet count Ͻ 40,000/ mL); (4) previous HCC treatment; (6) no foreseeable possibility for liver transplantation.…”

Section: Methodsmentioning

confidence: 99%

“…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.…”

mentioning

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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“…Percutaneous ethanol injection was first reported in the early 1980s [280][281][282]. 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].…”

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

confidence: 99%

“…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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Percutaneous ethanol injection for small hepatocellular carcinoma: Therapeutic efficacy based on 20-year observation

Cited by 183 publications

References 28 publications

Clinical significance of tumor markers in detection of recurrent hepatocellular carcinoma after radiofrequency ablation

Clinical significance of tumor markers in detection of recurrent hepatocellular carcinoma after radiofrequency ablation

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

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