Evaluation of combined therapy with transarterial chemoembolization and percutaneous ethanol injection for large hepatocellular carcinoma

Objective To assess the effects of combined transcatheter arterial chemoembolization(TACE) and percutaneous ethanol injection(PEI) in patients with large hepatocellular carcinoma(HCC).Methods A total of 63 patients with large unresectable HCC was treated with TACE followed by PEI.The largest dimension of the tumours ranged from 5.3 cm to 17.8 cm.Survival rates,acute effects,toxicity and prognostic factors were analysed.Follow-up ranged from 3 months to 62 months.Results The cumulative survival rates at 1,3 and 5 years were 59.4%,28.4% and 15.8% respectively(median survival is 27.7 months).A reduction of tumor area greater than 50%,was achieved in 48.6% of cases.In 86.9% of the cases with increased a-feto protein(AFP) values,AFP level underwent a reduction of more than 75%.The combination therapy was generally well tolerated.Only two patient died from variceal bleeding associated with therapy.The Cox proportional hazards model showed that the number of tumours the tumor margin and the ethanol dose were independent prognostic factors.Conclusion The results indicate that combined TACE with PEI is a promising therapeutic approach for large unresectable HCC.