Treatment of small hepatocellular carcinoma: a comparison of techniques and long-term results.
OBJECTIVE
The aim of this study was to compare the results over time of transcatheter arterial chemoembolization (TACE), percutaneous ethanol injection (PEI), laser thermal ablation (LTA) and combined therapy in the treatment of small hepatocellular carcinoma.


METHODS
Between 1998 and 2004, 131 cirrhosis patients (99 Child-Pugh class A, 32 Child-Pugh class B) with a small hepatocellular carcinoma were included in the study; 34 were treated with PEI, 46 with LTA, 18 with TACE and 33 with combined therapy.


RESULTS
No major complication occurred during any procedure. Computed tomography scan showed that complete necrosis was achieved in 81% of treated nodules (120 out of 148); as a whole, the disease relapsed in 42 (32.0%) patients (with a disease-free interval of 17.0+/-13.7 months). The cumulative survival rates were 81.9, 35.7 and 20.8% at 12, 36 and 60 months respectively. A univariate analysis of survival showed statistically significant differences in the comparison between Child-Pugh class A with respect to Child-Pugh class B (P<0.0001) and between nodules with a diameter of 20 mm or less as opposed to larger than 20 mm (P=0.001). Patients subjected to LTA showed a statistically significant longer survival than those treated with TACE and PEI.


CONCLUSIONS
LTA proves to be the most effective treatment, affording reduced invasiveness, a limited number of sessions, complete necrosis in almost all cases and better total survival in the treated patients.
Ferrari
Francesco Saverio
FS
Department of Radiology, Siena University Hospital, Siena, Italy. ferrari@unisi.it
Stella
Andrea
A
Pasquinucci
Paolo
P
Vigni
Francesco
F
Civeli
Letizia
L
Pieraccini
Massimo
M
Magnolfi
Fabrizio
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D003131:Combined Modality Therapy; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007271:Injections, Intradermal; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000401:mortality / Q000628:therapy*; D028022:Low-Level Light Therapy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011446:Prospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed
D000970:Antineoplastic Agents; D000431:Ethanol