INTRALESIONAL ETHANOL IN THE TREATMENT OF UNRESECTABLE LIVER-CANCER

Percutaneous ethanol injection (PEI) under ultrasonography guidance ha s been widely tried in not advanced hepatocellular carcinoma (HCC). Te n years after the introduction of PEI, some conclusions of its indicat ions can be drawn. In our series, 210 cirrhotic patients were treated; 141 with multisession PEI in an outpatient clinic, 57 with ''single s ession'' PEI under general anesthesia, and 12 with both. The 1-, 3-, a nd 5-year survival rates (by Kaplan-Meier method) were 93%, 65%, and 4 1% for Child class A patients with single HCC less than or equal to 5 cm, and 88%, 47%, and 33% for patients with multiple HCC up to five le sions less than or equal to 5 cm. In these patients the local recurren ce rate was 15% and the new lesion rate at the 5-year follow-up was 74 %. One death due to hemorrhage from esophageal varices in a Child clas s C patient treated by single session PEI occurred. The large number o f cirrhotic patients enrolled in ultrasonography screening programs ha s created a large demand for effective, safe, repeatable, low-cost tre atment that can be offered at many centers. PEI meets all these requir ements. PEI is proposed as the treatment of choice for the mentioned p atients, excluding candidates for liver transplantation and surgical r esection according to the predictive adverse factors currently in use. ''Single session'' technique widened the indications of traditional P EI to larger lesions.