TREATMENT OF HEPATIC METASTASIZED CARCINOIDS WITH PERCUTANEOUS ETHANOL INJECTION - FOLLOW-UP OF 5 CASES

Background: Ethanol injection is widely used for treatment of hepatoce llular carcinoma and allows direct destruction of hepatic metastases b ut only a few results are published concerning other tumors. We report on the use of percutaneous ethanol injection under ultrasonographic g uidance for treatment of hepatic metastasized carcinoid tumors. Patien ts and methods: Five patients with liver metastases from a carcinoid t umor were treated by injection of 8 to 109 ml ethanol 95% (v/v) under local anesthesia into 1 to 21 metastases during one to seven sessions. On realtime ultrasonography areas became hyperechoic when diffused by ethanol. Destruction of treated metastases was documented by computed tomography or by nuclear magnetic resonance imaging showing disappear ance of perfusion by contrast media. Results: Reduction of urinary 5-h ydroxyindoleacetic acid excretion by more than 50% was documented in t hree patients. One of these patients was retreated one year later with out success because the injected ethanol vanished through gaps in the partly necrotic metastases. The right lobe of the liver of the fourth patient was already completely destroyed by metastases, thus only the smaller metastases were treated in the left lobe to prevent its destru ction. The fifth patient improved clinically but was not controlled by us. Conclusions: Percutaneous ethanol injection is an effective, simp le and quick treatment for hepatic metastasized carcinoids in our pati ents. Best results were achieved in lesions smaller than 3cm. Treatmen t of partly necrotic metastases should be avoided.