AIM： To evaluate the therapeutic effect and the indication of percutaneous ethanol injection （PEI）, radiofrequency ablation （RFA） and their combination in treatment of hepatocellular carcinoma （HCC）. METHODS： ...AIM： To evaluate the therapeutic effect and the indication of percutaneous ethanol injection （PEI）, radiofrequency ablation （RFA） and their combination in treatment of hepatocellular carcinoma （HCC）. METHODS： Two hundred and fifty-five patients with HCC received treatment of PEI, RFA or their combination. Group1 （〈 3 on in diameter, n=85） was treated with PEI, group2 （〈 3 cm in diameter, n=153） with RFA. Group3 （〉3 cm in diameter, n=86） was divided into two groups. Group 3a （/7=34） was treated with RFA, while group 3b （n=52） was treated with RFA for 2 wk after transcatheter arterial chemoembolization or PEI. Contrast-enhanced sonography was performed for 61 patients before and after RFA. Liver function and serum alpha-fetoprotein （AFP） were measured for all patients. Changes of the lesions on ultrasound and contrast-enhanced CT/HRI were evaluated for assessing the therapeutic responses. The 1-, 2-, 3- and 5-year survival rates were recorded after treatment. RESULTS： In group 1, the complete necrosis rate of lesions after 1 mo was 77.6% （66/85）. The level of AFP declined conspicuously after 1 mo. The 1-, 2-, 3- and 5-year survival rate after treatment was 80.0% （52/65）, 60.4% （32/53）, 52.5% （21/40） and 33.3% （7/21）, respectively. In group 2, the complete necrosis rate of lesions after 1 moh was 92.2% （141/153）. The level of AFP decreased conspicuously after i mo. The 1-, 2-, 3- and 5-year survival rate after treatment was 94.6% （88/93）, 73.2% （52/71）, 63.5% （33/52） and 46.4% （13/28）, respectively. In group 3a, the complete necrosis rate of lesions after 1 mo was 23.5% （8/34）. AFPdropped down to the normal level in only one patient after 1 mo. The 1-, 2- and 3-year survival rate after treatment was 47.6% （10/21）, 42.9% （6/14） and 27.3% （3/11）, respectively. Only one patient was still alive after 5 years. In group 3b, the complete necrosis rate of lesions after 1 mo was 57.7% （30/52）. The level of AFP decreased after 1 mo. The 1-, 2-, 3- and S-year survival rate after treatment was 68.6% （24/35）, 46.2% （12/26）, 36.8% （7/19） and 27.3% （3/11）, respectively. CONCLUSION： The therapeutic effect of RFA on small HCC is better than that of PEI. Small HCC is the optimal indication of RFA. For recurrent HCC （diameter〉3 cm）, the combined treatment of RFA and PEI/ACE should be used.展开更多
AIM： To evaluate long-term follow-up of minimum-sized hepatocellular carcinoma （HCC） treated with percutaneous ethanol injection （PEI）. METHODS： PEI was applied to 42 lesions in 31 patients （23 male and eight f...AIM： To evaluate long-term follow-up of minimum-sized hepatocellular carcinoma （HCC） treated with percutaneous ethanol injection （PEI）. METHODS： PEI was applied to 42 lesions in 31 patients （23 male and eight female） with HCC 〈 15 mm in diameter, over the past 15 years. RESULTS： Overall survival rate was 74.1% at 3 years, 49.9% at 5 years, 27.2% at 7 years and 14.5% at 10 years. These results are superior to, or at least the same as those for hepatic resection and radiofrequency ablation. Survival was affected only by liver function, but not by sex, age, etiology of Hepatitis B virus or Hepatitis C virus, α-fetoprotein levels, arterial and portal blood flow, histological characteristics, and tumor multiplicity or size. Patients in Chiid-Pugh class A and B had 5-, 7- and 10-years survival rates of 76.0%, 42.2% and 15.8%, and 17.1%, 8.6% and 0%, respectively （P = 0.025）. CONCLUSION： Treatment with PEI is best indicated for patients with HCC 〈 15 mm in Child-Pugh class A.展开更多
AIM: In the present study, the characteristics of PEI-RFA treatment were further elucidated by analyzing the relationship between the volume of coagulated necrosis and the energy requirement for ablation or the amount...AIM: In the present study, the characteristics of PEI-RFA treatment were further elucidated by analyzing the relationship between the volume of coagulated necrosis and the energy requirement for ablation or the amount of ethanol injected into HCC.METHODS: The volume of coagulated necrosis, total energy requirement and energy requirement for coagulation of per unit volume were examined in the groups of PEI-RFA and RFA alone using the Cool-tip RF system.RESULTS: The results showed that the volume of coagulated necrosis induced was significantly larger in PEI-RFA group than in routine RFA group, when the total energy administered was comparable in both groups.In PEI-RFA, enlargement of coagulated necrosis was admitted in 3 dimensions and the amount of energy requirement per unit volume of coagulated necrosis was negatively correlated with the amount of ethanol injected into HCC.CONCLUSION: These results suggest that, compared to RFA alone, PEI-RFA enables to induce comparable coagulated necrosis with smaller energy requirement, and that PEI-RFA is likely to be less invasive than RFA alone irrespective of inducing enhanced coagulated necrosis.Thus, simple prior injection of ethanol may make RFA treatment more effective and less invasive for the treatment of patients with HCC.展开更多
We report a case of hypovascular advanced hepa-tocellular carcinoma (HCC) successfully treated with a novel combination therapy of percutaneous ethanol-lipiodol injection (PELI) and intervention radiology (IVR),lipiod...We report a case of hypovascular advanced hepa-tocellular carcinoma (HCC) successfully treated with a novel combination therapy of percutaneous ethanol-lipiodol injection (PELI) and intervention radiology (IVR),lipiodol-targetting IVR (Lipi-IVR). The present case had a hypovascular HCC (3 cm in diameter) located in the S6 region of the liver. Although the tumor was not detectable at all by both of early and late phase of helical dynamic computed tomography (CT),it could be detected by ultrasonography (US) as a low echoic space occupying lesion (SOL) beside the gallbladder and right kidney. Serum levels of alpha fetoprotein (AFP) and AFP-L3 were extremely high. Combination therapy of PELI,firstly reported in our department,and IVR (PELI and IVR,lipiodol-targetting IVR) was performed twice for the treatment. PELI could effectively visualize the location of the tumor for IVR treatment and show the presence of a thin blood vessel branching from the right hepatic artery flowing into the lipiodol deposit. After treatment,the serum levels of AFP and AFP-L3 were rapidly decreased to normal and maintained for more than eight months. Thus,this case expressing the tremendous effect might give us insight into the effectiveness of the novel combination therapy of PELI and IVR for the treatment of hypovascular HCC.展开更多
基金Supported by the Natural Science Foundation of Guangdong province of China No.31710the Medical Research Foundation of the Bureau of Health of Guangdong Province of China No.A2003203
文摘AIM： To evaluate the therapeutic effect and the indication of percutaneous ethanol injection （PEI）, radiofrequency ablation （RFA） and their combination in treatment of hepatocellular carcinoma （HCC）. METHODS： Two hundred and fifty-five patients with HCC received treatment of PEI, RFA or their combination. Group1 （〈 3 on in diameter, n=85） was treated with PEI, group2 （〈 3 cm in diameter, n=153） with RFA. Group3 （〉3 cm in diameter, n=86） was divided into two groups. Group 3a （/7=34） was treated with RFA, while group 3b （n=52） was treated with RFA for 2 wk after transcatheter arterial chemoembolization or PEI. Contrast-enhanced sonography was performed for 61 patients before and after RFA. Liver function and serum alpha-fetoprotein （AFP） were measured for all patients. Changes of the lesions on ultrasound and contrast-enhanced CT/HRI were evaluated for assessing the therapeutic responses. The 1-, 2-, 3- and 5-year survival rates were recorded after treatment. RESULTS： In group 1, the complete necrosis rate of lesions after 1 mo was 77.6% （66/85）. The level of AFP declined conspicuously after 1 mo. The 1-, 2-, 3- and 5-year survival rate after treatment was 80.0% （52/65）, 60.4% （32/53）, 52.5% （21/40） and 33.3% （7/21）, respectively. In group 2, the complete necrosis rate of lesions after 1 moh was 92.2% （141/153）. The level of AFP decreased conspicuously after i mo. The 1-, 2-, 3- and 5-year survival rate after treatment was 94.6% （88/93）, 73.2% （52/71）, 63.5% （33/52） and 46.4% （13/28）, respectively. In group 3a, the complete necrosis rate of lesions after 1 mo was 23.5% （8/34）. AFPdropped down to the normal level in only one patient after 1 mo. The 1-, 2- and 3-year survival rate after treatment was 47.6% （10/21）, 42.9% （6/14） and 27.3% （3/11）, respectively. Only one patient was still alive after 5 years. In group 3b, the complete necrosis rate of lesions after 1 mo was 57.7% （30/52）. The level of AFP decreased after 1 mo. The 1-, 2-, 3- and S-year survival rate after treatment was 68.6% （24/35）, 46.2% （12/26）, 36.8% （7/19） and 27.3% （3/11）, respectively. CONCLUSION： The therapeutic effect of RFA on small HCC is better than that of PEI. Small HCC is the optimal indication of RFA. For recurrent HCC （diameter〉3 cm）, the combined treatment of RFA and PEI/ACE should be used.
文摘AIM： To evaluate long-term follow-up of minimum-sized hepatocellular carcinoma （HCC） treated with percutaneous ethanol injection （PEI）. METHODS： PEI was applied to 42 lesions in 31 patients （23 male and eight female） with HCC 〈 15 mm in diameter, over the past 15 years. RESULTS： Overall survival rate was 74.1% at 3 years, 49.9% at 5 years, 27.2% at 7 years and 14.5% at 10 years. These results are superior to, or at least the same as those for hepatic resection and radiofrequency ablation. Survival was affected only by liver function, but not by sex, age, etiology of Hepatitis B virus or Hepatitis C virus, α-fetoprotein levels, arterial and portal blood flow, histological characteristics, and tumor multiplicity or size. Patients in Chiid-Pugh class A and B had 5-, 7- and 10-years survival rates of 76.0%, 42.2% and 15.8%, and 17.1%, 8.6% and 0%, respectively （P = 0.025）. CONCLUSION： Treatment with PEI is best indicated for patients with HCC 〈 15 mm in Child-Pugh class A.
文摘AIM: In the present study, the characteristics of PEI-RFA treatment were further elucidated by analyzing the relationship between the volume of coagulated necrosis and the energy requirement for ablation or the amount of ethanol injected into HCC.METHODS: The volume of coagulated necrosis, total energy requirement and energy requirement for coagulation of per unit volume were examined in the groups of PEI-RFA and RFA alone using the Cool-tip RF system.RESULTS: The results showed that the volume of coagulated necrosis induced was significantly larger in PEI-RFA group than in routine RFA group, when the total energy administered was comparable in both groups.In PEI-RFA, enlargement of coagulated necrosis was admitted in 3 dimensions and the amount of energy requirement per unit volume of coagulated necrosis was negatively correlated with the amount of ethanol injected into HCC.CONCLUSION: These results suggest that, compared to RFA alone, PEI-RFA enables to induce comparable coagulated necrosis with smaller energy requirement, and that PEI-RFA is likely to be less invasive than RFA alone irrespective of inducing enhanced coagulated necrosis.Thus, simple prior injection of ethanol may make RFA treatment more effective and less invasive for the treatment of patients with HCC.
文摘We report a case of hypovascular advanced hepa-tocellular carcinoma (HCC) successfully treated with a novel combination therapy of percutaneous ethanol-lipiodol injection (PELI) and intervention radiology (IVR),lipiodol-targetting IVR (Lipi-IVR). The present case had a hypovascular HCC (3 cm in diameter) located in the S6 region of the liver. Although the tumor was not detectable at all by both of early and late phase of helical dynamic computed tomography (CT),it could be detected by ultrasonography (US) as a low echoic space occupying lesion (SOL) beside the gallbladder and right kidney. Serum levels of alpha fetoprotein (AFP) and AFP-L3 were extremely high. Combination therapy of PELI,firstly reported in our department,and IVR (PELI and IVR,lipiodol-targetting IVR) was performed twice for the treatment. PELI could effectively visualize the location of the tumor for IVR treatment and show the presence of a thin blood vessel branching from the right hepatic artery flowing into the lipiodol deposit. After treatment,the serum levels of AFP and AFP-L3 were rapidly decreased to normal and maintained for more than eight months. Thus,this case expressing the tremendous effect might give us insight into the effectiveness of the novel combination therapy of PELI and IVR for the treatment of hypovascular HCC.
