Ultrasound-guided percutaneous alcohol injection of small liver metastases. Results in 40 patients

Abstract

Background. Ultrasound‐guided percutaneous alcohol injection (PAI) is used in the treatment of hepatocellular carcinoma. The aim of this study is to evaluate the results of treatment with PAI of liver metastases (LM) that measure fewer than 5 cm in diameter, where three or less lesions are present. Methods. Between December 1987 and November 1992, 40 patients were treated for one or more liver tumors (n ≦ 3). These 40 patients had a total of 55 lesions. There were 55 LM: 32 cases of colorectal origin, 9 cases of mammary origin, 5 cases with a carcinoid tumor, 4 with an undifferentiated tumor, 3 with cancer of the uterus, 1 with an epidermoid cancer of the esophagus, and 1 with a bronchogenic carcinoma. The tumor has been considered spherical and the total volume of alcohol used depends on the diameter of the tumor. The volume was calculated using the formula V = 4/3Π[r + 0.5]3; this volume was injected during several sessions, not more than 10 ml per injection. The injections were performed once a week until the calculated volume was reached. Results. Of the 55 tumors treated, there was a complete necrosis in 31 cases (56.3%). The median survival of the 40 patients was 21 months, with a 3‐year actuarial survival of 39%. Among patients with LM of colorectal origin, the median survival was increased when the total necrosis was obtained (38 months versus 21 months, P < 0.04). Conclusion. PAI seems to be a therapeutic alterative when surgery is contraindicated or when LM are resistant to chemotherapy.

Role of percutaneous ethanol ablation in malignant liver tumours

“…Tumours > 3.2 cm (3 cases) remained positive for malignant cells. So results of our study is comparable to Giovannini et al [7] The difference in success rate between Giorgio et al and our study could be explained by the fact that our study had larger tumours (up to 4.5 cm liver metastasis).…”

“…Complete necrosis was seen in 9 (50%) tumours of liver metastasis in our study. Of the 55 liver metastatic tumours ablated with ethanol by Giovannini et al, [7] there was a complete necrosis in 31 cases (56.3%) and partial necrosis in 16 cases (29.1%). The lesions were unchanged in eight cases (14.1%).…”

“…[5] PEI had been less successfully used in treatment of liver secondaries and cholangiocarcinomas. [6][7][8] Currently, RFA is a first-line treatment of the major local ablative techniques but PEI is preferred in technically difficult masses located in the hepatic dome, in the subcapsular area, and exophytic in position, or are surrounded by large blood vessels. [9] …”

Chemical Tumor Ablation with Use of a Novel Multiple-tine Infusion System in a Canine Sarcoma Model

“…In addition to different infusion fluid, the tumor type itself is likely to influence the size and quality of ablation for multiple-tine infusion, given that standard needle infusion yields different results for hepatocellular carcinoma and colorectal carcinoma (2,3,10). Results will need to be refined for each tumor and clinical scenario.…”

Isolated Colorectal Liver Metastases Locally Progressing after Stereotactic Body Radiotherapy Rescued with Surgery

“…local tumour ablation can be accomplished with direct intratumoral instillation of alcohol 3 or acetic acid 4 or with hyperthermic ablation 5 or cryotherapy 6 . In general, lesions that are amenable to surgical resection also lend themselves to ablative treatments.…”