title: Intraoperative US-guided large volume ethanol injection for hepatocellular carcinoma greater than 4 cm.
abstract: BACKGROUND
  Percutaneous ethanol injection has been successfully used for hepatocellular carcinomas (HCC) smaller than 5 cm in size. For larger lesions large volume ethanol injection has not been well explored.
  
  
  OBJECTIVE
  Evaluate the results of intraoperative Ultrasonographic-guided large volume ethanol injection for HCC larger than 4 cm in size.
  
  
  METHODS
  Ten patients were candidates for this treatment between June 1999 and July 2003. A retrospective review of the clinical files was performed. Absolute ethanol, average of 100 mL (range 80-120 mL) was administered intraoperatively. Follow-up evaluation included alpha-fetoprotein (AFP) and ultrasound or computed tomography.
  
  
  RESULTS
  There were six women and four men, the median age was 62 years (range 56-80). The median lesion size was 8 cm (range 4-15 cm). Hepatitis C liver cirrhosis was the most common associated chronic liver disease (70%). A significant reduction of AFP levels after treatment was observed (Initial 966 ng/dL, post treatment levels: 42 ng/dL) US and CT scan showed tumor necrosis. Morbidity was 40%. No operative mortality was recorded. The one and four year survival rate was 60% and 20%.
  
  
  CONCLUSIONS
  Intraoperative US-guided large volume ethanol injection is a safe palliative therapy for cirrhotic patients with HCC lesions greater than 5 cm in size. The impact on survival should be compared in a controlled double blind study.
authors.affiliation: Department of Gastroenterology, Institutuo Nacional de Cancerología, Mexico City, Division of Surgery, Centro Médico ISSEMyM, Metepec, México. rymmondragon@aol.com
authors.forename: Ricardo
authors.initials: R
authors.lastname: Mondragón-Sánchez
authors.forename: Ana Lilia
authors.initials: AL
authors.lastname: Garduño-López
authors.forename: Elvira
authors.initials: E
authors.lastname: Gómez-Gómez
authors.forename: Mauricio
authors.initials: M
authors.lastname: Frias-Mendivil
authors.forename: Alejandro
authors.initials: A
authors.lastname: Mondragón-Sánchez
authors.forename: Rigoberto
authors.initials: R
authors.lastname: Bernal-Maldonado
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015552:Injections, Intralesional; D007813:Laparotomy; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012997:Solvents / Q000008:administration & dosage*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D012997:Solvents; D000509:alpha-Fetoproteins; D000431:Ethanol