Small hepatocellular carcinoma: treatment with US-guided intratumoral injection of acetic acid.
OBJECTIVE
To assess the efficacy of ultrasound-guided percutaneous acetic acid injection (PAI) in the treatment of hepatocellular carcinoma (HCC).


METHODS
Results of a preliminary study in rats showed that the effectiveness of acetic acid in the destruction of hepatocytes plateaued at a concentration of 50%. Thus, PAI with 50% acetic acid was performed in 25 patients with solitary HCCs 3 cm or less in diameter. The viability of tumor cells after PAI was examined by means of contrast material-enhanced computed tomography (CT) and fine-needle biopsy in all patients. Two patients underwent partial hepatic resection.


RESULTS
No clinically significant complications occurred in 82 treatment sessions. All lesions became smaller after a mean of 23 months +/- 8 (standard deviation) of follow-up. There was no evidence of viable HCC at follow-up biopsy and CT. Two HCCs obtained by means of resection showed complete necrosis. The 1-year survival rate among 23 patients who did not undergo surgical treatment was 100%; the 2-year survival rate was 92%.


CONCLUSIONS
PAI may prove to be an effective therapy for small HCC.
Third Department of Medicine, Saitama Medical School, Japan.
K
K
Ohnishi
N
N
Ohyama
S
S
Ito
K
K
Fujiwara
D000085:Acetates / Q000008:administration & dosage*; D019342:Acetic Acid; D000368:Aged; D000818:Animals; D001707:Biopsy, Needle; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D051381:Rats; D017207:Rats, Sprague-Dawley; D015996:Survival Rate; D013997:Time Factors; D018084:Ultrasonography, Interventional
D000085:Acetates; D019342:Acetic Acid