[Single-session alcohol administration for hepatocarcinoma].
We investigated the long-term efficacy and the contraindications of single-session percutaneous ethanol injection (PEI) under general anesthesia in hepatocellular carcinoma (HCC). One hundred patients were treated from October, 1991, to April, 1996: 24 patients had a single capsulated HCC, 4.5 to 10 cm phi (group A); 62 had a single infiltrating tumor or multiple lesions (3 to 6), with 10 cm maximum phi (group B); 14 patients were in an advanced stage because of Child class C or of infiltrating tumors with portal thrombosis, with 14 cm lesion maximum phi (group C). Group A patients were treated because they were not operable or refused surgery. Three to 22 injections were performed (mean: 13) depending on tumor size and ethanol spread. The maximum injected volume of ethanol was 190 ml (mean: 57 ml). The procedure took 20 to 50 minutes (mean: 30 minutes). The mean hospital stay was 3.5 days. Tumor necrosis was complete in 58% of encapsulated tumors and > 70% in infiltrating lesions. The greatest lesion with complete post-PEI necrosis was 8.2 cm phi. A transient and variable increase in transaminase, bilirubin, white cell and D-dimer levels and a decrease in red cell, platelet, hemoglobin, fibrinogen and haptoglobin levels were observed. These changes were due to hepatic cell necrosis, hemolysis and focal thrombosis. One death (bleeding esophageal varices in the Child C patient)(1%) and four major complications (one peritoneal bleeding, one liver decompensation, two chemical segmentectomies with pain)(4%) were observed. 1, 2, 3 year survival rates for groups A, B and C were: 80, 63, 63%; 70, 50, 30% and 58, 14 and 0% respectively. In our experience, PEI was an efficacious procedure. The risk conditions are: superficial lesion site with severe coagulation defects, severe portal and/or pulmonary hypertension, esophageal varices at risk of bleeding, cardiac ischemia, advanced cirrhosis.
Livraghi
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Reparto di Radiologia, Ospedale Civile, Vimercate, MI.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy*; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged
D000431:Ethanol