Local Ablative Therapies in HCC: Percutaneous Ethanol Injection and Radiofrequency Ablation

Abstract

Hepatocellular carcinoma (HCC) is the most common primary hepatic malignancy. Surgery and transarterial chemoembolization have for many years dominated the local treatment of HCC. The introduction of image-guided percutaneous techniques for local tumor ablation changed the treatment of liver cancer. Percutaneous ethanol injection (PEI) and radiofrequency ablation (RFA) have both successfully been employed in the treatment of HCC. In current guidelines both techniques are recommended as standard therapy in limited liver cancer. From the current literature both techniques have to be considered safe and effective in the treatment of HCC. Several randomized trials showed RFA to be superior to PEI for treating small HCC. Moreover, several studies analyzed survival after PEI or RFA in comparison with surgery, proving interventional therapy to be a serious competitor of resection. With introduction of combined interventional therapies including transarterial chemoembolization, PEI and RFA survival was improved further. In this article, we provide an insight into the technical basics of PEI and RFA and review the clinical results and indications of these interventional techniques in the treatment of HCC.

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

“…As compared with other articles about PEI therapy for HCCs in favorable location, similar therapeutic results were obtained. [1][2][3][4][5][6][7][8][9] Of note is the report of Kuang et al 10 that the effectiveness and complication rate of PEI therapy for treating tumors in unfavorable location for RFA were similar to those of PEI therapy for treating tumors in favorable location for RFA.…”

“…4,5,8 The combination of TACE and PEI therapy, TACE and RFA, or RFA and PEI therapy is more effective than each of the monotherapies in preventing incomplete necrosis, especially in advanced disease or when tumors are in close proximity to large vessels. 1 Using combination therapies with TACE, RFA, and PEI therapy, it is also suited for tumors up to 5-7 cm, especially effective for tumors 3-5 cm. Thus, the use of multimodal treatment regimens needs to be expanded.…”

“…In contrast, RFA generates heat around the radiofrequency electrode tip, which is distributed homogeneously in all directions, and ablates tissue around tip, irrespective of tumor tissue or normal structure. 1 As most metastatic HCCs usually have adjacent vital structures, PEI therapy would be safer than RFA.…”

“…[1][2][3][4][5] Non-surgical therapy of HCC is based on radiofrequency ablation (RFA), percutaneous ethanol injection (PEI) therapy, and transcatheter arterial chemoembolization (TACE), with RFA and PEI therapy being effective in small HCC and TACE being the method of choice in advanced tumor stage. [1][2][3] RFA enables more effective tumor necrosis in fewer treatment sessions, albeit with a higher rate of complications than does PEI therapy. 1,6,7 Because of its high local recurrence rate, PEI therapy has been replaced by newer and more effective thermal ablation techniques.…”

“…[1][2][3] RFA enables more effective tumor necrosis in fewer treatment sessions, albeit with a higher rate of complications than does PEI therapy. 1,6,7 Because of its high local recurrence rate, PEI therapy has been replaced by newer and more effective thermal ablation techniques. 6 It is reasonable to reserve PEI therapy for HCCs that are difficult to approach with RFA or located in areas where RFA is considered unsafe.…”