Hepatocellular carcinoma: treatment with a combination therapy of transcatheter arterial embolization and percutaneous ethanol injection.

Abstract

In an attempt to obtain complete tumor necrosis in large hepatocellular carcinoma (HCC) lesions, the authors studied the clinical and histologic findings of a new combination therapy, percutaneous ethanol injection (PEI) with transcatheter arterial embolization (TAE) (pretreatment with TAE and subsequent PEI) in 15 patients with a single, large (3.0-9.0 cm in diameter), encapsulated lesion of HCC. Two weeks after TAE, PEI was performed under ultrasound guidance. A total of four to 11 injections were administered at a rate of one injection twice a week. During the follow-up period (range, 7-23 months), all lesions were reduced in size and no evidence of HCC was present at contrast material-enhanced computed tomography or angiography in nine of 11 patients who did not subsequently undergo surgery. Six patients had a follow-up of 1 year or more, for a 1-year survival rate of 100%. Four patients subsequently underwent surgical resection; complete necrosis of the tumor was observed in all four. The authors conclude that a combination of PEI and TAE is an appropriate treatment for patients with large, encapsulated HCC lesions who are poor surgical risks.

Prospective study of α-fetoprotein in cirrhotic patients monitored for development of hepatocellular carcinoma

“…Fewer than 20% of patients with HCC in Japan undergo liver resection, mainly because the underlying cirrhosis makes surgery impossible (19). Other treatments are effective, such as percutaneous ethanol injection (20)(21)(22) and transcatheter arterial embolization (23,24), which offer the possibility of cure. The survival rate of patients with advanced liver disease has improved, so it is inappropriate to monitor patients with cirrhosis of Child class A alone.…”

Successful initial ablation therapy contributes to survival in patients with hepatocellular carcinoma

“…Patients with impaired clotting tests, or with a lower platelet count less than 5 × 10 10 /L were considered as being contraindicated for RF ablation and were treated by PEI. Ten patients (23% of patients treated by PEI) with tumors more than 3 cm in diameter were treated with TACE followed by PEI [18] . We used a real-time convex scanner or linear-array scanner with 3.5-MHz probes and a lateral attachable apparatus for needle guidance (Core-Vision 6000 TM , Toshiba Medical Co., Tokyo, Japan).…”

Imaging Blood Flow Characteristics of Hepatocellular Carcinoma

“…Furthermore, the retention of lipiodol in HCC lesions sometimes makes it difficult to distinguish the hyperattenuating area of contrast enhancement from that of lipiodol when the retention of iodized oil in tumors is incomplete [46,47].…”