Transarterial Ethanol Ablation of Hepatocellular Carcinoma with Lipiodol–Ethanol Mixture: Phase II Study

• Published in: Journal of vascular and interventional radiology Vol. 19; no. 1; pp. 95 - 103
• Main Authors: Yu, Simon C.H., MD, FRCR, Hui, Edwin P., FRCP, Wong, John, FRCS, Wong, Herman, FRCP, Mo, Frankie, BSc, Ho, Simon S.M., FRCS, Wong, Yuen Y., FRCS, Yeo, Winnie, MD, FRCP, Lai, Paul B.S., MD, FRCS, Chan, Anthony T.C., MD, FRCP, Mok, Tony S.K., MD, FRCP
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 2008
• Subjects: Adult; Aged; Aged, 80 and over; Angiography, Digital Subtraction; Carcinoma, Hepatocellular - blood supply; Carcinoma, Hepatocellular - diagnostic imaging; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - therapy; Chemoembolization, Therapeutic - adverse effects; Chemoembolization, Therapeutic - methods; Disease-Free Survival; Ethanol; Female; Humans; Iodized Oil - administration & dosage; Liver Neoplasms - blood supply; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - mortality; Liver Neoplasms - therapy; Male; Middle Aged; Proportional Hazards Models; Prospective Studies; Radiology; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; TACE; TEA; HCC; transcatheter arterial chemoembolization; transarterial ethanol ablation; hepatocellular carcinoma
• ISSN: 1051-0443; 1535-7732
• DOI: 10.1016/j.jvir.2007.08.038

Purpose This prospective trial aimed to evaluate the safety and effectiveness of transarterial ethanol ablation (TEA) of intrahepatic lesions of hepatocellular carcinoma (HCC) with a Lipiodol–ethanol mixture. Materials and Methods Seventy-seven patients were recruited and 164 lesions (mean size, 5.2 cm ± 3.0) were treated. Inclusion criteria included histologic proof of HCC, refusal of ( n = 9) or contraindication to ( n = 68) surgical resection, Eastern Cooperative Oncology Group performance status no greater than 2, and intrahepatic disease without vascular invasion. The mixture consisted of 33% ethanol by volume, with the total dose of Lipiodol–ethanol mixture limited to 60 mL for each treatment session. The primary endpoint was patient survival. Secondary endpoints were tumor response, adverse effects of treatment, and progression-free survival. Median follow-up time for the whole cohort was 2.3 years. Results Median overall survival was 2.2 years. Overall survival and progression-free survival rates at 1 year and 2 years were 77.9% and 50.1% and 63.6% and 46.3%, respectively. Complete ablation according to radiologic criteria was achieved in 61 patients (79.2%) and 86% of the 164 treated lesions. Mean tumor volume reduction was 65.22%. Patient survival was significantly better in patients with tumors no larger than 5 cm (Cox proportional-hazards regression, P = .0074). Treatment response was significantly better for patients with tumors no greater than 7 cm (χ2 test, P = .0462; Fisher exact test, P = .0326). Adverse effects included irreversible hepatic decompensation (0.6% of procedures), pain (4.8%), and fever (13.8%). Conclusions TEA is a safe and effective means to establish local control of unresectable and resectable intrahepatic lesions of HCC.