COMBINATION THERAPY OF TRANSCATHETER CHEMOEMBOLIZATION AND PERCUTANEOUS ETHANOL INJECTION THERAPY

The therapeutic effectiveness of a combination therapy - pretreatment with transcatheter arterial chemoembolization (TACE) followed by percu taneous ethanol injection (PEI) therapy - for large (>3 cm in diameter ) unresectable hepatocellular carcinoma (HCC) was compared with that o f TACE alone. PEI therapy was performed in 24 cases of unresectable HC C that had previously been treated with TACE using doxorubicin 30-60 m g or epirubicin 50-90 mg. In all, 2-10 ml of 90% ethanol mixed with ca rbocaine was repeatedly injected through a 21-gauge, closed-end needle (PEIT needle) for a median of 3.6 injections and 31.1 ml of ethanol. As adverse effects, transient localized pain and a burning sensation w ere observed in 75.0% of the cases; fever, in 66.7%; and transient hyp otension, in two cases. A small unresectable tumor is a good indicatio n for PEI therapy. In cases with a larger tumor, i.e., measuring more than 3 cm in diameter, or multiple tumors, the 1-year survival rate ob tained with this combination therapy, i.e., TACE and PEI, was 87.0%, a nd the 2-year survival rate was 65.2%. These rates were greater than t hose obtained with TACE alone. Accordingly, additional PEI therapy was effective for larger tumors and multiple tumors previously treated wi th TACE.