Carbon dioxide-enhanced sonographically guided percutaneous ethanol injection: Treatment of patients with viable and recurrent hepatocellular carcinoma

OBJECTIVE. Viable portions of tumors can persist and recurrent tumors sometimes appear in patients with hepatocellular carcinoma who have undergone transcatheter arterial chemoembolization, percutaneous ethanol injection, or a combination of the two. Some of these tumors are difficult to treat or do not respond to additional treatment using the same protocol. In this article, we examine the use of carbon dioxide (CO2)-enhanced sonographically guided percutaneous ethanol injection to treat patients with such tumors. SUBJECTS AND METHODS. Our study population was 44 patients with 53 viable portions of tumors or recurrent hepatocellular carcinomas that had developed after the initial treatment of the primary tumor. The tumors were treated with CO2-enhanced sonographically guided percutaneous ethanol injection via the catheter that had been placed in the hepatic artery for angiography. Thirty-seven (84.1%) of the 44 patients had cirrhosis. Of these 37 patients, 23 had Child-Pugh class A cirrhosis, and 14 had Child-Pugh class B. RESULTS. Overall, thirty-four (64.2%) of the 53 tumors showed complete necrosis after treatment, eight (15.1%) of the 53 showed partial necrosis, and 11 (20.8%) of the 53 showed no response. The cumulative survival rates of patients who underwent CO2-enhanced sonographically guided percutaneous ethanol injection were 81%, 71%, and 44% for 1, 2, and 3 years, respectively. The small tumors were more responsive to the treatment. The tumor recurrence rate was 56.8%. In 9.1% of these cases, carcinoma had metastasized to other organs. CONCLUSION. CO2-enhanced sonographically guided percutaneous ethanol injection is effective for patients with viable portions of a treated tumor or new tumors who have undergone transcatheter arterial chemoembolization, percutaneous ethanol injection, or a combination of the two treatments. This finding is especially true of patients who are not good candidates for repeated treatments.