Improved survival with percutaneous ethanol injection in patients with large hepatocellular carcinoma

Abstract

Objective: To evaluate the efficacy of percutaneous ethanol injection in the management of patients with large hepatocellular carcinoma. Design: Prospective controlled study. Ten patients were randomized to receive percutaneous ethanol injection and five served as controls. Setting: Tertiary hospital. Participants: Fifteen patients with large (>5cm) lesions with or without cirrhosis and no ascites. Mean tumour size in the percutaneous ethanol injection group (82.5 ±59 cm²) and in the control group (87.1 ±58 cm²) was comparable. Intervention: Percutaneous ethanol injection was performed under ultrasound guidance. Repeated injections (mean 5.1±1.6 sessions) were given and a mean 38.8±8.3 ml ethanol was injected per patient until the lesion appeared 'marble like' at ultrasound. Results: There was a significant (P< 0.01 ) decrease in the median tumour size (median 14%; range, 0–68%) in nine of the 10 patients compared with a 20% increase in size in the untreated patients. Median survival in the percutaneous ethanol injection group was 9 months (range, 4–38 months) and 5 months in the control group (range, 1–8 months); the difference was significant (P<0.05). Conclusion: Percutaneous ethanol injection is a safe and effective technique which arrests tumour growth, may decrease tumour size and can improve survival in patients with large hepatocellular carcinoma.