Percutaneous ethanol injection in the treatment of hepatocellular carcinoma in cirrhosis

Background/Aims: In this study we discuss and evaluate the use of percutane ous ethanol injection for the treatment of hepatocellular carcinoma in cirr hosis. Methodology: Percutaneous ethanol injection was performed under ultrasound guidance, with multiple Sessions at an outpatient department or with "singl e-session" technique under general anesthesia, according to the size and nu mber of the lesions. Results: In our patients with Child A (293), B (149), or C (20) cirrhosis a nd single hepatocellular carcinoma 5cm or smaller, the 1-, 3- and 5-year su rvival rates were 98, 79 and 47%, 93, 63 and 29%, and 64, 12 and 0%, respec tively. In our 108 patients with larger hepatocellular carcinoma, 1- and 3- year survival rates were: 72 and 57% in single, encapsulated tumors, 73 and 42% in single infiltrating or multiple encapsulated tumors, and 46 and 0% in symptomatic or with advanced portal thrombosis tumors. Conclusions: Percutaneous ethanol injection proved to be a safe, effective, repeatable, easy and low-cost therapy for hepatocellular carcinoma. Surviv al after percutaneous ethanol injection was comparable to that after surgic al resection, probably because of a balancing between greater complete abla tion rate of surgery versus absence of early mortality and liver damage of percutaneous ethanol injection. On the basis of the percutaneous ethanol in jection rationale, other ablation techniques were proposed using radiofrequ ency, laser or acetic acid. Their initial results are promising.