Combined Treatment of Large Hepatocellular Carcinoma with Transcatheter Arterial Chemoembolization and Percutaneous Ethanol Injection with a Multipronged Needle: Experimental and Clinical Investigation

Purpose This study was designed to evaluate the usefulness of percutaneous ethanol injection (PEI) with a multipronged needle for the treatment of large hepatocellular carcinoma (HCC). An experimental animal study and a clinical investigation were performed. Methods In the experimental study, 20 ml of 99.5% ethanol was injected into porcine liver in vivo with a multipronged needle (n = 5) or a straight needle (n = 5), and the volumes of coagulation necrosis were compared. In the clinical investigation, PEI was performed in 17 patients (10 men, 7 women; mean age 73.4 +/- 6.7 years) with single, large HCC (mean tumor diameter, 47.2 +/- 11.5 mm; range, 32-70 mm) by using a multipronged needle. Fifteen of 17 patients received transarterial chemoembolization (TACE) before PEI. Results The volume of coagulation in porcine liver in vivo was significantly increased with the multipronged needle compared with the straight needle (longest perpendicular diameters, 34.2 +/- 3.6 mm 9 30.2 +/- 3.6 mm vs. 22.6 +/- 2.5 mm 9 19 +/- 2.2 mm, respectively; P < 0.05). In the clinical trial, initial complete response (CR) of the tumor was achieved in 17 of 17 patients, 7 of whom required two PEI sessions. During the follow-up, local recurrence was detected in 4 of 17 patients at 3-19 months after the procedure, for a rate of sustained local CR of 76%. No major complication occurred. Conclusions Use of a multipronged needle substantially increases the volume of coagulation in vivo with respect to the conventional PEI technique. Combined TACE and PEI with multipronged needles is a safe and effective option for percutaneous treatment of single, large HCC.