title: Destructive effect of percutaneous hydrochloric acid injection therapy for liver cancer--a preliminary experimental and clinical study.
abstract: OBJECTIVE
  To evaluate the tissue coagulation and anticancer effects of hydrochloric acid compared with ethanol and acetic acid. To assess the in situ destructive effects and safety of CT mediated percutaneous hydrochloric acid injection therapy (PHAIT).
  
  
  METHODS
  IC50 of gastric juice and 10% diluted hydrochloric acid against cancer cell lines in vitro were determined. Coagulated necrotic area of hydrochloric acid was observed in vitro and in vivo using pig liver. The coagulated effects of 6 mol/l hydrochloric acid solution (HAS6) on pig liver and muscle were compared with 50% acetic acid and anhydrous alcohol. Thirty patients with 38 lesions of liver cancer were treated by the CT mediated intratumor injection of HAS6. The in situ destructive rate, CT evaluation, PET, histopathology, survival and side effects were observed.
  
  
  RESULTS
  The IC50 of gastric juice and 10% diluted hydrochloric acid against cancer cell lines were as similar as approximately 0.05-0.07% in concentration. Coagulated area of liver tissue by 1 ml of 1.5-12 mol/l hydrochloric acid was 18.3-53.4 mm in diameter. The globular hoariness coagulation area with a clear-cut borderline separated from normal tissue was produced. The 6.0 mol/l hydrochloric acid shows a larger coagulation dimension with a clear boundary, 15 times of anhydrous alcohol and 5 times of 50% acetic acid. No toxicities in the routine local injection dosages were found. Clinically, the patients received 73 sessions of PHAIT; CT scan shows a low density area with gas that did not enhance by CT scan shown 24 hrs later. A good necrosis and destruction rate of cancer was obtained by PET, biopsy and AFP measurement. One year, 2-year and 3-year survival rates were 100, 90 and 85%, respectively. Nine cases survived more than 3 years, and 2 cases for more than 4 years. No change in the heart, liver and kidney functions were found. Main side effects were slight pain, lower fever, etc.
  
  
  CONCLUSIONS
  The 6 mol/l hydrochloric acid is an effective endogenetic protein coagulator; the cancer tissue coagulated effect of HAS6 was superior to 50% acetic acid and anhydrous alcohol. CT mediated percutaneous hydrochloric acid injection therapy showed good destructive effects; it would be used as a new minimum invasive treatment for percutaneous treatment of liver cancer, instead of acetic acid and anhydrous alcohol with its safety, controllability and no poisonous effects.
authors.affiliation: Dept. of Medical Oncology, Beijing Shijitan Hospital of No.9 Clinical Medical College of Peking University, PR China.
authors.forename: Feng
authors.initials: F
authors.lastname: Weijian
authors.forename: Liu
authors.initials: L
authors.lastname: Zan
authors.forename: Han
authors.initials: H
authors.lastname: Suhong
authors.forename: Zhang
authors.initials: Z
authors.lastname: Hongmei
authors.forename: Zhou
authors.initials: Z
authors.lastname: Lei
authors.forename: Zhao
authors.initials: Z
authors.lastname: Yanjie
authors.forename: Cao
authors.initials: C
authors.lastname: Yi
authors.forename: Jiang
authors.initials: J
authors.lastname: Ni
mesh_terms: D019342:Acetic Acid / Q000008:administration & dosage; D000818:Animals; D045744:Cell Line, Tumor / Q000187:drug effects; D000431:Ethanol / Q000008:administration & dosage; D005750:Gastric Juice; D006801:Humans; D006851:Hydrochloric Acid / Q000008:administration & dosage* / Q000009:adverse effects; D066298:In Vitro Techniques; D015552:Injections, Intralesional; D008099:Liver / Q000187:drug effects; D008113:Liver Neoplasms / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate; D013552:Swine
chemical_list: D000431:Ethanol; D019342:Acetic Acid; D006851:Hydrochloric Acid