Percutaneous ethanol injection therapy for hepatocellular carcinoma: results in 146 patients.

Shiina, Shuichiro; Tagawa, Kunio; Niwa, Yuki; Unuma, Tadao; Komatsu, Yutaka; Yoshiura, Kenta; Hamada, Eiji; Takahashi, Masashi; Shiratori, Yasushi; Terano, Akira

doi:10.2214/ajr.160.5.7682378

Cited by 363 publications

(198 citation statements)

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“…However, another injection was given if it was needed and the patient tolerated it. Both PAI and PEI were performed twice a week and repeated until the total amount of absolute ethanol (V1) or 50% acetic acid (V2) injected in all sessions for each tumor reached the volume calculated using Equation 1, proposed by Shiina et al, 17 and Equation 2, proposed by us; in the latter the capability of 50% acetic acid to necrotize hepatocytes is assumed to be more than 3 times that of absolute ethanol. 25,26 V1(mL) ϭ 4 3 ϫ 3.14 ϫ (r ϩ 0.5) 3 (Eq.…”

Section: Methodsmentioning

confidence: 99%

“…Percutaneous ethanol injection (PEI) is now widely carried out for small HCC. [15][16][17][18][19][20][21] The effect of PEI is almost comparable with that of surgical resection. 5,6,[16][17][18][19] However, a large number of treatment sessions are required [15][16][17][18][19][20] and recurrence after treatment is very common.…”

mentioning

confidence: 99%

“…[15][16][17][18][19][20][21][22] The latter is indicated for both hypervascular and hypovascular HCCs, whereas TAE is only for hypervascular HCCs; small HCCs are frequently hypovascular. Percutaneous ethanol injection (PEI) is now widely carried out for small HCC.…”

mentioning

confidence: 99%

“…5,6,[16][17][18][19] However, a large number of treatment sessions are required [15][16][17][18][19][20] and recurrence after treatment is very common. [17][18][19][20][21] In the course of development of US-guided percutaneous injection of a material to kill cancer cells, we took up acetic acid that has a strong tissue penetrating capabilities as it dissolves lipids and extracts collagen. 23,24 First, we showed in rats that the capability of acetic acid to necrotize hepatocytes was enhanced with increasing concentrations till its killing effect plateaued at 50%.…”

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Prospective randomized controlled trial comparing percutaneous acetic acid injection and percutaneous ethanol injection for small hepatocellular carcinoma

et al. 1998

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To assess whether ultrasound-guided percutaneous acetic acid injection is superior to percutaneous ethanol injection in the treatment of small hepatocellular carcinoma (HCC), 60 patients with one to four HCCs smaller than 3 cm were entered onto a randomized controlled trial. Thirty-one and 29 patients, respectively, were treated by percutaneous acetic acid injection using 50% acetic acid or by percutaneous ethanol injection using absolute ethanol. There were no significant differences in age, sex ratio, Child-Pugh class, size of tumors, or number of tumors between the two groups. When there was no evidence of viable HCC from biopsy, plain and helical dynamic computed tomography, or angiography, the treatment was considered successful and was discontinued. All original tumors were treated successfully by either therapy. However, 8% of 38 tumors treated with percutaneous acetic acid injection and 37% of 35 tumors treated with percutaneous ethanol injection developed a local recurrence (P F .001) during the follow-up periods of 29 ؎ 8 months and 23 ؎ 10 months, respectively. The 1-and 2-year survival rates were 100% and 92% in percutaneous acetic acid injection and 83% and 63% in percutaneous ethanol injection (P ‫؍‬ .0017). A multivariate analysis of prognostic factors revealed that treatment was an independent predictor of survival. The risk ratio of percutaneous acetic acid injection versus percutaneous ethanol injection was 0.120 (range, 0.027-0.528; P ‫؍‬ .0050). In conclusion, percutaneous acetic acid injection is superior to percutaneous ethanol injection in the treatment of small HCC. (HEPATOLOGY 1998;27:67-72.)Hepatocelluar carcinoma (HCC) is one of the major malignancies with poor prognosis in eastern Asia, especially China, Japan, Taiwan, Singapore, and Korea, as well as Sub-Saharan Africa 1 ; the estimated incidence is approximately 1,250,000 deaths per year worldwide. 2 The early detection strategies for HCC have increased the number of small resectable HCCs in regions where they are endemic. [3][4][5] The survival rates reported after resection have improved in the last decade, mainly because of the increasingly smaller sizes of resected tumors. 4-9 Some surgical teams have thus achieved a 50% 5-year rate of survival in patients with small, asymptomatic HCCs. 5,6 However, resection is possible in a small proportion of patients because of the underlying advanced cirrhosis. Orthotopic liver transplantation is also an effective treatment for small, unresectable HCCs, but potential recipients far outnumber donors.Such difficulty in the management of HCC prompted the development of other potentially curative therapeutic modalities such as transcatheter hepatic arterial embolization (TAE) 13,14 and ultrasound (US)-guided percutaneous injection of materials that will kill cancer cells. [15][16][17][18][19][20][21][22] The latter is indicated for both hypervascular and hypovascular HCCs, whereas TAE is only for hypervascular HCCs; small HCCs are frequently hypovascular. Percutaneous ethanol injection (PEI) is...

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Section: Methodsmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Prospective randomized controlled trial comparing percutaneous acetic acid injection and percutaneous ethanol injection for small hepatocellular carcinoma

et al. 1998

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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%

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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Impact of Histological Grade of Hepatocellular Carcinoma on the Outcome of Liver Transplantation

et al. 2001

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Histological grade of hepatocellular carcinoma (HCC) is an important prognostic factor affecting patient survival after orthotopic liver transplantation (OLT).Design: Retrospective analysis.Setting: University-based teaching hospital.Patients: Of 952 OLTs performed between June 1991 and January 1999, 56 OLT recipients had histologically proven HCC in the explant liver. Of those, 53 patients with complete clinicopathologic data were analyzed. A single pathologist blinded to the outcome of each patient reviewed all histological specimens.Results: Median follow-up was 709 days. Overall survival for patients with tumors sized 5 cm or less at 1, 3, and 5 years was 87%, 78%, and 71%, respectively (Kaplan-Meier). Univariate analysis revealed the size, number, and distribution of tumors; the presence of microscopic vascular invasion and lymph node metastasis; histological differentiation; and pTNM stage to be statistically

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Percutaneous ethanol injection therapy for hepatocellular carcinoma: results in 146 patients.

Cited by 363 publications

References 6 publications

Prospective randomized controlled trial comparing percutaneous acetic acid injection and percutaneous ethanol injection for small hepatocellular carcinoma

Prospective randomized controlled trial comparing percutaneous acetic acid injection and percutaneous ethanol injection for small hepatocellular carcinoma

Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

Impact of Histological Grade of Hepatocellular Carcinoma on the Outcome of Liver Transplantation

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