Long term results of single session percutaneous ethanol injection in patients with large hepatocellular carcinoma

Tito Livraghi, Viviano Benedini, Sergio Lazzaroni, Franca Meloni, Guido Torzilli, Claudio Vettori

Research output: Contribution to journalArticle

138 Citations (Scopus)

Abstract

BACKGROUND. The objective of this study was to evaluate the indications for percutaneous ethanol injection (PEI) performed in a single session under general anesthesia for treating patients with cirrhosis and large (tumors > 5 cm) hepatocellular carcinoma (HCC), and relevant survival curves. METHODS. Between November 1991 and November 1996, 108 patients were treated (a total of 128 procedures). They fell into 3 groups: 24 patients with single, encapsulated HCC measuring from 5-8.5 cm (Group A); 63 patients with single, infiltrating HCC measuring from 5-10 cm or multiple HCC (Group B); and 21 patients with advanced disease, either hepatic (Child's Class C) or neoplastic (symptomatic HCC or with portal thrombosis) type (Group C). The mean amount of ethanol injected was 62 mL. The average hospital stay was 3.8 days. The mean follow-up time was 40 months. RESULTS. The 1-, 2-, 3-, and 4- year survival rates were: 72%, 65%, 57%, and 44%, respectively, for Group A; 73%, 60%, 42%, and 16%, respectively, for Group B; and 46%, 25%, and 0%, respectively, for Group C. Mortality was 0.7% (bleeding from esophageal varices in a Child's Class C patient). The rate of major complications was 4.6% (1 case of peritoneal hemorrhage, 1 case of severe liver failure, 1 case of transient renal insufficiency, 1 case of peritoneal seeding, and 2 cases of infarctions of a segment adjacent to the tumor). CONCLUSIONS. Single session PEI has been proven to be a valid alternative in patients otherwise treated surgically or with transcatheter arterial chemoembolization who present with adverse prognostic factors or risks for these therapies, and may be an option for selected patients with advanced disease previously excluded from any therapy. Risk conditions are marked portal or pulmonary hypertension or esophageal varices at risk of bleeding, superficial tumors with severe coagulation disorders, hyperfibrinolysis, chronic renal insufficiency, and obstructive jaundice.

Original languageEnglish
Pages (from-to)48-57
Number of pages10
JournalCancer
Volume83
Issue number1
DOIs
Publication statusPublished - Jul 1 1998

Fingerprint

Hepatocellular Carcinoma
Ethanol
Injections
Esophageal and Gastric Varices
Hemorrhage
Neoplasms
Obstructive Jaundice
Liver Failure
Portal Hypertension
Chronic Renal Insufficiency
Pulmonary Hypertension
General Anesthesia
Infarction
Renal Insufficiency
Length of Stay
Thrombosis
Fibrosis
Survival Rate
Survival
Mortality

Keywords

  • Alcohol
  • Hepatocellular carcinoma
  • Interventional procedures
  • Liver
  • Liver neoplasms
  • Therapy

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Long term results of single session percutaneous ethanol injection in patients with large hepatocellular carcinoma. / Livraghi, Tito; Benedini, Viviano; Lazzaroni, Sergio; Meloni, Franca; Torzilli, Guido; Vettori, Claudio.

In: Cancer, Vol. 83, No. 1, 01.07.1998, p. 48-57.

Research output: Contribution to journalArticle

Livraghi, Tito ; Benedini, Viviano ; Lazzaroni, Sergio ; Meloni, Franca ; Torzilli, Guido ; Vettori, Claudio. / Long term results of single session percutaneous ethanol injection in patients with large hepatocellular carcinoma. In: Cancer. 1998 ; Vol. 83, No. 1. pp. 48-57.
@article{1ed597d0e3b34c27b005c4ff56997f61,
title = "Long term results of single session percutaneous ethanol injection in patients with large hepatocellular carcinoma",
abstract = "BACKGROUND. The objective of this study was to evaluate the indications for percutaneous ethanol injection (PEI) performed in a single session under general anesthesia for treating patients with cirrhosis and large (tumors > 5 cm) hepatocellular carcinoma (HCC), and relevant survival curves. METHODS. Between November 1991 and November 1996, 108 patients were treated (a total of 128 procedures). They fell into 3 groups: 24 patients with single, encapsulated HCC measuring from 5-8.5 cm (Group A); 63 patients with single, infiltrating HCC measuring from 5-10 cm or multiple HCC (Group B); and 21 patients with advanced disease, either hepatic (Child's Class C) or neoplastic (symptomatic HCC or with portal thrombosis) type (Group C). The mean amount of ethanol injected was 62 mL. The average hospital stay was 3.8 days. The mean follow-up time was 40 months. RESULTS. The 1-, 2-, 3-, and 4- year survival rates were: 72{\%}, 65{\%}, 57{\%}, and 44{\%}, respectively, for Group A; 73{\%}, 60{\%}, 42{\%}, and 16{\%}, respectively, for Group B; and 46{\%}, 25{\%}, and 0{\%}, respectively, for Group C. Mortality was 0.7{\%} (bleeding from esophageal varices in a Child's Class C patient). The rate of major complications was 4.6{\%} (1 case of peritoneal hemorrhage, 1 case of severe liver failure, 1 case of transient renal insufficiency, 1 case of peritoneal seeding, and 2 cases of infarctions of a segment adjacent to the tumor). CONCLUSIONS. Single session PEI has been proven to be a valid alternative in patients otherwise treated surgically or with transcatheter arterial chemoembolization who present with adverse prognostic factors or risks for these therapies, and may be an option for selected patients with advanced disease previously excluded from any therapy. Risk conditions are marked portal or pulmonary hypertension or esophageal varices at risk of bleeding, superficial tumors with severe coagulation disorders, hyperfibrinolysis, chronic renal insufficiency, and obstructive jaundice.",
keywords = "Alcohol, Hepatocellular carcinoma, Interventional procedures, Liver, Liver neoplasms, Therapy",
author = "Tito Livraghi and Viviano Benedini and Sergio Lazzaroni and Franca Meloni and Guido Torzilli and Claudio Vettori",
year = "1998",
month = "7",
day = "1",
doi = "10.1002/(SICI)1097-0142(19980701)83:1<48::AID-CNCR7>3.0.CO;2-A",
language = "English",
volume = "83",
pages = "48--57",
journal = "Cancer",
issn = "0008-543X",
publisher = "John Wiley and Sons Inc.",
number = "1",

}

TY - JOUR

T1 - Long term results of single session percutaneous ethanol injection in patients with large hepatocellular carcinoma

AU - Livraghi, Tito

AU - Benedini, Viviano

AU - Lazzaroni, Sergio

AU - Meloni, Franca

AU - Torzilli, Guido

AU - Vettori, Claudio

PY - 1998/7/1

Y1 - 1998/7/1

N2 - BACKGROUND. The objective of this study was to evaluate the indications for percutaneous ethanol injection (PEI) performed in a single session under general anesthesia for treating patients with cirrhosis and large (tumors > 5 cm) hepatocellular carcinoma (HCC), and relevant survival curves. METHODS. Between November 1991 and November 1996, 108 patients were treated (a total of 128 procedures). They fell into 3 groups: 24 patients with single, encapsulated HCC measuring from 5-8.5 cm (Group A); 63 patients with single, infiltrating HCC measuring from 5-10 cm or multiple HCC (Group B); and 21 patients with advanced disease, either hepatic (Child's Class C) or neoplastic (symptomatic HCC or with portal thrombosis) type (Group C). The mean amount of ethanol injected was 62 mL. The average hospital stay was 3.8 days. The mean follow-up time was 40 months. RESULTS. The 1-, 2-, 3-, and 4- year survival rates were: 72%, 65%, 57%, and 44%, respectively, for Group A; 73%, 60%, 42%, and 16%, respectively, for Group B; and 46%, 25%, and 0%, respectively, for Group C. Mortality was 0.7% (bleeding from esophageal varices in a Child's Class C patient). The rate of major complications was 4.6% (1 case of peritoneal hemorrhage, 1 case of severe liver failure, 1 case of transient renal insufficiency, 1 case of peritoneal seeding, and 2 cases of infarctions of a segment adjacent to the tumor). CONCLUSIONS. Single session PEI has been proven to be a valid alternative in patients otherwise treated surgically or with transcatheter arterial chemoembolization who present with adverse prognostic factors or risks for these therapies, and may be an option for selected patients with advanced disease previously excluded from any therapy. Risk conditions are marked portal or pulmonary hypertension or esophageal varices at risk of bleeding, superficial tumors with severe coagulation disorders, hyperfibrinolysis, chronic renal insufficiency, and obstructive jaundice.

AB - BACKGROUND. The objective of this study was to evaluate the indications for percutaneous ethanol injection (PEI) performed in a single session under general anesthesia for treating patients with cirrhosis and large (tumors > 5 cm) hepatocellular carcinoma (HCC), and relevant survival curves. METHODS. Between November 1991 and November 1996, 108 patients were treated (a total of 128 procedures). They fell into 3 groups: 24 patients with single, encapsulated HCC measuring from 5-8.5 cm (Group A); 63 patients with single, infiltrating HCC measuring from 5-10 cm or multiple HCC (Group B); and 21 patients with advanced disease, either hepatic (Child's Class C) or neoplastic (symptomatic HCC or with portal thrombosis) type (Group C). The mean amount of ethanol injected was 62 mL. The average hospital stay was 3.8 days. The mean follow-up time was 40 months. RESULTS. The 1-, 2-, 3-, and 4- year survival rates were: 72%, 65%, 57%, and 44%, respectively, for Group A; 73%, 60%, 42%, and 16%, respectively, for Group B; and 46%, 25%, and 0%, respectively, for Group C. Mortality was 0.7% (bleeding from esophageal varices in a Child's Class C patient). The rate of major complications was 4.6% (1 case of peritoneal hemorrhage, 1 case of severe liver failure, 1 case of transient renal insufficiency, 1 case of peritoneal seeding, and 2 cases of infarctions of a segment adjacent to the tumor). CONCLUSIONS. Single session PEI has been proven to be a valid alternative in patients otherwise treated surgically or with transcatheter arterial chemoembolization who present with adverse prognostic factors or risks for these therapies, and may be an option for selected patients with advanced disease previously excluded from any therapy. Risk conditions are marked portal or pulmonary hypertension or esophageal varices at risk of bleeding, superficial tumors with severe coagulation disorders, hyperfibrinolysis, chronic renal insufficiency, and obstructive jaundice.

KW - Alcohol

KW - Hepatocellular carcinoma

KW - Interventional procedures

KW - Liver

KW - Liver neoplasms

KW - Therapy

UR - http://www.scopus.com/inward/record.url?scp=0032127345&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0032127345&partnerID=8YFLogxK

U2 - 10.1002/(SICI)1097-0142(19980701)83:1<48::AID-CNCR7>3.0.CO;2-A

DO - 10.1002/(SICI)1097-0142(19980701)83:1<48::AID-CNCR7>3.0.CO;2-A

M3 - Article

VL - 83

SP - 48

EP - 57

JO - Cancer

JF - Cancer

SN - 0008-543X

IS - 1

ER -