Therapeutic Efficacy and Safety of Percutaneous Ethanol Injection with or without Combined Radiofrequency Ablation for Hepatocellular Carcinomas in High Risk Locations

• Published in: Korean journal of radiology Vol. 14; no. 2; pp. 240 - 247
• Main Authors: Cha, Dong Ik, Lee, Min Woo, Rhim, Hyunchul, Choi, Dongil, Kim, Young-sun, Lim, Hyo K.
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Society of Radiology 01.03.2013; 대한영상의학회
• Subjects: Ablation; Aged; Aged, 80 and over; Ascites; Carcinoma, Hepatocellular - drug therapy; Carcinoma, Hepatocellular - surgery; Catheter Ablation - methods; Chemoembolization, Therapeutic - methods; Disease Progression; Electrodes; Ethanol; Ethanol - administration & dosage; Female; Fentanyl; Hepatitis; Humans; Intervention; Liver cancer; Liver Neoplasms - drug therapy; Liver Neoplasms - surgery; Local anesthesia; Magnetic Resonance Imaging; Male; Medical prognosis; Middle Aged; Postoperative Complications; Retrospective Studies; Statistics, Nonparametric; Tomography, X-Ray Computed; Tumors; 방사선과학; Radiofrequency ablation; Complication; Hepatocellular carcinoma; Liver imaging; Percutaneous ethanol injection
• ISSN: 1229-6929; 2005-8330; 2005-8330
• DOI: 10.3348/kjr.2013.14.2.240

To evaluate the therapeutic efficacy and safety of percutaneous ethanol injection (PEI) alone and combined with radiofrequency ablation (RFA) for hepatocellular carcinomas (HCCs) in high risk locations. We performed PEI for HCCs in RFA-high risk locations, either alone or in combination with RFA. There were 20 HCCs (1.7 ± 0.9 cm) in 20 patients (PEI group: n = 12; PEI + RFA group: n = 8). We evaluated technical success, local tumor progression and complications in both groups. Technical success was achieved in all HCCs in both groups. During follow-up, local tumor progression was found in 41.7% (5/12) in the PEI group, whereas 12.5% (1/8) for the PEI + RFA group (p = 0.32). Bile duct dilatation was the most common complication, especially when the tumors were in periportal locations; 55% (5/9) in the PEI group and 50% (2/4) in the PEI + RFA group (p = 1.00). One patient in the PEI group developed severe biliary stricture and upstream dilatation that resulted in atrophy of the left hepatic lobe. One patient treated with PEI + RFA developed cholangitis and an abscess. Combined PEI and RFA treatment has a tendency to be more effective than PEI alone for managing HCCs in high risk locations, although the difference is not statistically significant. Even though PEI is generally accepted as a safe procedure, it may cause major biliary complications for managing HCCs adjacent to the portal vein.