Percutaneous Ethanol Lipiodol Injection Therapy versus Radiofrequency Ablation in Treatment of Hepatocellular Carcinoma

Abstract

Background & aim: Percutaneous ethanol injection (PEI) has become one of the most widely used procedures for treatment of hepatocellular carcinoma (HCC) up to 5 cm. PEI is occasionally ineffective due to in homogenous distribution within tumor while percutaneous ethanol lipiodol injection therapy (PELIT) is useful irrespective of vasculature, as HCC cells are characterized by selective, active uptake of lipiodol. The primary outcome was the higher success rate of PELIT with fewer sessions in comparison to RFA in HCC. Patients and methods:A prospective study was conducted on 43 patients with HCC, 27 of them under went PELIT & 16 underwent RFA. Both groups had biopsy after one week and lesions with partial necrosis underwent additional PELIT or RFA respectively. Triphasic MRI and CT were performed one month after the end of sessions of PELIT and RFA respectively.Results: Tru-cut biopsy revealed complete necrosis in 17 (81%) patients of PELIT and 11(68.7%) patients of RFA group. Six patients of PELIT group were not biopsied due to non-visible lesions by ultrasound, ascites or low PC. After additional sessions (in partial necrosis), triphasic MRI for PELIT group showed non-enhancement in 26(92.3%) patients and triphasic CT for RFA group showed non-enhancement in 15 (93.6%) patients and one patient in each group showed peripheral enhancement. Conclusion:PELIT is safe & effective for treatment of HCC, the number of sessions are equal to the diameter of HCC in cm (fewer sessions than RFA or PEI alone). PELIT can be performed for cases liable or contraindicated to RFA. Triphasic MRI is the standard for follow up of cases of PELIT.