Incidence of needle tract seeding and responses of soft tissue metastasis by hepatocellular carcinoma postradiotherapy.
OBJECTIVE
To determine the incidence of needle tract seeding after fine needle aspiration (FNA) or percutaneous ethanol injection (PEI) and compare iatrogenic or spontaneous soft tissue metastasis (STM) by hepatocellular carcinoma (HCC) postradiotherapy (RT) in responses.


METHODS
From November 1997 to January 2006, those who presented with STM by HCC after our invasive procedures or developed spontaneously were enrolled into this retrospective study. Metastatic lesions could be divided into procedure related (PR), which were located at the liver span and were related to invasive procedures, and non-procedure related (NPR), which were in extrahepatic areas. STM was treated with an electron or photon beam.


RESULTS
A total of 39 HCC cases with developed STM were referred for RT, including 17 in the PR group and 22 in the NPR group. During the same period, a total of 18,227 person-times of FNA or PEI were performed on these HCC patients. The overall incidence of HCC with STM that was caused by invasive procedures was estimated at 0.13%. According to the Cox' regression model, the initial treatment modality influences the time duration after the initial diagnosis of HCC when STM has not occurred. None of these patients' soft tissue tumor increased in size during RT. The PR group had lower rates of bone metastasis (P=0.003) and coexisting extrahepatic metastasis (P=0.011) and a longer survival rate (P=0.003) than the NPR group. The estimated rates of 18-gauge and 22-gauge needle-induced HCC-related STM were 0.60% and 0.11%, respectively (P=0.064).


CONCLUSIONS
The PR group bears a better prognosis than the NPR group post-RT.
Tung
Wei-Chih
WC
Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, The Division of Hepato-Gastroenterology, Chang Gung University College of Medicine, Niaosung Hsiung, Taiwan.
Huang
Yu-Jie
YJ
Leung
Stephen Wan
SW
Kuo
Fang-Ying
FY
Tung
Hung-Da
HD
Wang
Jing-Houng
JH
Hung
Chao-Hung
CH
Lee
Chuan-Mo
CM
Changchien
Chi-Sin
CS
Yeh
Shih-An
SA
Sun
Li-Min
LM
Huang
Eng-Yen
EY
Hsu
Hsuan-Chih
HC
Wang
Chong-Jong
CJ
Lu
Sheng-Nan
SN
D000279:Administration, Cutaneous; D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle / Q000009:adverse effects; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000532:radiotherapy* / Q000556:secondary*; D000431:Ethanol / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D015994:Incidence; D007267:Injections / Q000009:adverse effects; D008113:Liver Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009339:Needles / Q000009:adverse effects*; D009366:Neoplasm Seeding; D011379:Prognosis; D012189:Retrospective Studies; D012983:Soft Tissue Neoplasms / Q000453:epidemiology / Q000532:radiotherapy* / Q000556:secondary*; D016019:Survival Analysis; D016896:Treatment Outcome
D000431:Ethanol