Is Percutaneous Ethanol Injection Therapy Still Effective for Hepatocellular Carcinoma in the Era of Radiofrequency Ablation?

Abstract

Percutaneous ethanol injection (PEI) therapy has been replaced by more-effective thermal ablation techniques that have lower local recurrence rates. However, PEI therapy remains useful in certain settings. Since PEI can be performed in any portion of the liver, PEI therapy can be valuable when tumors are located in close proximity to intestinal loops or other positions that are risky for thermal local ablative techniques. PEI therapy is also valuable in other situations where radiofrequency ablation (RFA) is difficult, including technically difficult masses that are not detected with ultrasound (US), are located in the hepatic dome, in the subcapsular area, and exophytically, or are surrounded by large vessels. PEI therapy contributes to combination therapy with transcatheter arterial chemoembolization or RFA in advanced-stage hepatocellular carcinoma (HCC), and also to the treatment of large HCC or extrahepatic metastasis from HCC. These roles of PEI therapy should be stressed for the treatment of HCCs in appropriate clinical situations. This comprehensive review of articles related to PEI therapy illustrates the recent role and indications of this therapy, which is currently valuable for HCC in the era of RFA. (Gut Liver 2010;4(Suppl. 1):S105-112)

Radiofrequency ablation-combined multimodel therapies for hepatocellular carcinoma: Current status

“…Up to 25% of small liver tumors are located in adjacent normal structures, such as the portal vein, bile ducts, gallbladder or the subcapsular areas in contact with the diaphragm and intestinal tracts [33]; the efficacy of RFA decreases since the operators have to carefully consider the balance between sufficient ablation of lesions and avoiding collateral thermal injury to these vital structures. Under these circumstances, PEI can be considered a better strategy [34]. …”

Usefulness of F-18 FDG PET/CT in the Evaluation of Early Treatment Response After Interventional Therapy for Hepatocellular Carcinoma

“…Therefore, interventional therapy has gained an increasing role in the treatment of HCC. This HCC therapy is based on radiofrequency ablation (RFA), percutaneous ethanol injection therapy (PEIT), and transcatheter arterial chemoembolization (TACE), with RFA and PEIT being effective in relatively small HCC and TACE being the main interventional therapy in large or advanced intrahepatic HCC [2,6,7].…”

Predictive factors for the success of "one-off" ablation in single hepatocellular carcinoma patients who underwent percutaneous radiofrequency ablation

“…Tumor location included deep-parenchyma (307 patients, 66.5%) and sub-capsular (155 patients, 43.5%). Among them, 109 (23.6%) tumors were close to organs (space between tumor and organ < 1 cm) [13] (22 nodules close to stomach, 48 close to gallbladder, 23 close to jejunum, 8 close to pericardium, and 17 close to kidney), and 40 tumors (3.9%) were close to the main blood vessels (between tumor and vessels < 5 mm) [11] such as post-hepatic vena cava, hepatic vein, and the portal vein.…”