title: Treatment of small hepatocellular carcinoma with acetic acid percutaneous injection.
abstract: Percutaneous ablation using acetic acid is an attractive method because of its low morbidity and low number of sessions required to induce complete tumor necrosis. Moreover, the real-time fluoroscopy CT scan could improve the technique by improving distribution of the necrotizing agent within the tumor.
  
  
  OBJECTIVE
  To determine the feasibility and the long-term results of the acetic acid percutaneous injection under CT fluoroscopy guidance in a series of cirrhotic patients with small hepatocellular carcinoma in a single French center.
  
  
  METHODS
  One hundred and two patients with hepatocellular carcinoma were evaluated for treatment between 1999 and 2000. The selection criteria for fluoroscopy CT scan-directed percutaneous acetic acid ablation were: 1) one to three nodules<5 centimeters; 2) Child-Pugh class<13; 3) prothrombin index > 40% and platelet count > 50000 per mm(3) and 4) contraindication to both resection and liver transplantation. Post treatment follow-up included ultrasonography, magnetic resonance and alphafetoprotein levels every 3 months. Recurrence and survival rates were estimated using the Kaplan-Meier method.
  
  
  RESULTS
  Forty-nine patients (48%) could benefit from a curative treatment, most of them (37/49) being eligible for fluoroscopy CT scan-directed percutaneous acetic acid. The mean follow up was 24.4 +/- 2.7 months. Complete tumor necrosis was achieved in 28 patients (76%) after a mean of 1.6 sessions. In these 28 patients, the recurrence rates were 34% and 48% and survival rates were 76% and 70%, at 24 and 36 months, respectively. No serious complications occurred during or after the treatment.
  
  
  CONCLUSIONS
  Percutaneous ablation using acetic acid using CT fluoroscopy guidance may be considered as a short term efficient, low risk treatment and can be applied even in patients with ascites or severe hemostatic abnormalities. However, the high rate of recurrence and the early occurrence of multifocal hepatocellular carcinoma underline the limits of this method as well as of all other percutaneous strategies.
authors.affiliation: Service d'Hépatologie, Hôpital Saint-Antoine, Hôpitaux de Paris, Université Pierre et Marie Curie, Paris.
authors.forename: Laetitia
authors.initials: L
authors.lastname: Fartoux
authors.forename: Lionel
authors.initials: L
authors.lastname: Arrive
authors.forename: Tony
authors.initials: T
authors.lastname: Andreani
authors.forename: Lawrence
authors.initials: L
authors.lastname: Serfaty
authors.forename: Olivier
authors.initials: O
authors.lastname: Chazouillères
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Tubiana
authors.forename: Raoul
authors.initials: R
authors.lastname: Poupon
authors.forename: Olivier
authors.initials: O
authors.lastname: Rosmorduc
mesh_terms: D019342:Acetic Acid / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D005240:Feasibility Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015552:Injections, Intralesional; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology
chemical_list: D000970:Antineoplastic Agents; D019342:Acetic Acid