BACKGROUND: Percutaneous ethanol injection has been successfully used for small single HCC lesions 5 cm or less in size. For bigger lesions the place of large volume ethanol injection has not been well explored. OBJECTIVE: To evaluate the results of intraoperative US-guided large volume ethanol injection for HCC lesions greater than 4 cm in size.
METHODS: Between June 1999 and June 2000, ten patients with unresectable HCCs were candidates for this treatment. A retrospective review of the clinical files was performed. During surgery a single session of absolute ethanol (99.5%) was instilled under US control. An average of 100 ml (range 80-120 ml) was administered. Follow-up evaluation included alpha-fetoprotein (AFP) levels and US or computed tomography (CT). Morbidity and mortality were analyzed. Survival was determined by Kaplan Meier method.
RESULTS: There were four men and six women with a median age of 62 years (range 56-80 years). The median size of the lesions was 8 cm (range 4-15 cm). Seven patients had concomitant hepatitis C liver cirrhosis, two patients had hepatitis B and C liver cirrhosis, and one case was not associated to a chronic liver disease. A significant reduction of AFP levels after treatment was observed (Initial median AFP: 966 ng/dl, post treatment levels: 42 ng/dl) US and CT scan showed a variable reduction in size. Postoperative complications included: pleural effusion, GI bleeding, fever and transient hypotension (morbidity 40%), No mortality was recorded. The 1 year survival rate after treatment was 60%.
CONCLUSIONS: Intraoperative US-guided large volume ethanol injection is a safe palliative therapy for patients with HCC lesions greater than 4 cm in size. We believe that this procedure could increase the survival in cirrhotics patients with unresectable HCC. However, prospective and randomized studies are needed to demonstrate this observation.
