Long-term follow-up arterial chemoembolization combined with transportal ethanol injection used to treat hepatocellular carcinoma

PURPOSE: This study was undertaken to evaluate the long-term efficacy of transcatheter hepatic arterial chemoembolization (TACE) combined with transportal ethanol injection (TPEI) in patients with hepatocellular carcinoma (HCC), MATERIALS AND METHODS: Twenty-six patients with unresectable HCC underwent TPEI 2-6 weeks after TACE, The size of the main tumor ranged from 2.0 to 9.0 cm (mean, 4.5 cm), Ethanol (10-65 mL) was injected via a percutaneous transhepatic approach into the portal vein, perfusing the segment to be treated. TACE was repeated after TPEI in 18 patients. RESULTS: The combined therapy was technically successfully in all 26 cases; however, irreversible hepatic failure developed in two (8%) patients. Recurrent disease occurred either from the treated lesion (four patients) or apart from the treated liver segment (five patients) in nine of 21 patients (43%) followed up for a mean of 34 months. The survival rates were 87%, 72%, 72%, 63%, 51, and 51% at 1, 2, 3, 4, 5, and 6 years, respectively. Resected and autopsied specimens showed complete necrosis in seven of nine main lesions and severe parenchymal damage in the treated liver segment. CONCLUSION: In selected patients, combined treatment with TACE and TPEI is safe and effective, decreasing recurrence rate in the treated segment, and resulting in a 51% 6-year survival.