Efficacy analysis of transcatheter arterial chemoembolization combined with conventional percutaneous ethanol injection therapy in the treatment of 40 cases of primary liver cancer / 中国综合临床

Objective To study the curative effect of transcatheter arterial chemoembolization( TACE) combined with conventional percutaneous ethanol injection therapy ( PEIT) in the treatment for primary liver cancer?Methods Forty cases patients with primary liver cancer(the diameter was equal or more than 8 cm) who were treat in the Third Hospital of Qinhuangdao from January 2007 to May 2013 were selected,and randomly divided into treatment group(20 cases) and control group(20 cases)?The control group underwent TACE,the treatment group were given TACE combined with PEIT, the clinical effect of the two groups were observed?Results The effective rate of the treatment group was 80%,significantly higher than that of the control group( 50%) ,the difference was statistically significant( P=0?04)?During the follow?up of 3 years,there were 3 cases of portal vein tumor thrombus,5 cases of hepatic metastasis,1 case of upper gastrointestinal bleeding and 2 cases of liver failure in the control group;there were 1 case of liver metastasis,1 case of liver failure and death in the treatment group?Conclusion The test of the curative effect of patients with huge hepatocellular carcinoma after combination therapy with TACE and PEIT proved combination therapy can increase the curative effect, decrease impairment of liver funvtion?It was a palliation road to treat huge hepatocellular carcinoma.

Is Percutaneous Ethanol Injection Therapy Still Effective for Hepatocellular Carcinoma in the Era of Radiofrequency Ablation?

Percutaneous ethanol injection (PEI) therapy has been replaced by more-effective thermal ablation techniques that have lower local recurrence rates. However, PEI therapy remains useful in certain settings. Since PEI can be performed in any portion of the liver, PEI therapy can be valuable when tumors are located in close proximity to intestinal loops or other positions that are risky for thermal local ablative techniques. PEI therapy is also valuable in other situations where radiofrequency ablation (RFA) is difficult, including technically difficult masses that are not detected with ultrasound (US), are located in the hepatic dome, in the subcapsular area, and exophytically, or are surrounded by large vessels. PEI therapy contributes to combination therapy with transcatheter arterial chemoembolization or RFA in advanced-stage hepatocellular carcinoma (HCC), and also to the treatment of large HCC or extrahepatic metastasis from HCC. These roles of PEI therapy should be stressed for the treatment of HCCs in appropriate clinical situations. This comprehensive review of articles related to PEI therapy illustrates the recent role and indications of this therapy, which is currently valuable for HCC in the era of RFA.

A case of advanced hepatocellular carcinoma with portal vein tumor invasion controlled by percutaneous ethanol injection therapy / 대한간학회지

Portal vein invasion is a grave prognostic indicator in the setting of hepatocellular carcinoma (HCC). There is currently no effective method for preventing the invasion of HCC into the main portal vein. We report here a case of advanced HCC with portal vein tumor thrombosis that was effectively treated with percutaneous ethanol injection (PEI), having previously enabled subsequent successive transarterial chemoembolization (TACE). A 60-year-old male patient was diagnosed with a huge HCC, based on computed tomography and angiographic findings. Despite two sessions of TACE, the tumor invaded the right portal vein. PEI was performed on the malignant portal vein thrombosis, and three sessions thereof reduced the extent of tumor thrombi in the portal vein. Successive TACEs were performed to treat the HCC in the hepatic parenchyma. The patient was still living 19 months after the first PEI with no evidence of tumor recurrence, and his liver function remained well preserved.

Needle Tract Implantation after Percutaneous Interventional Procedures in Hepatocellular Carcinomas: Lessons Learned from a 10-year Experience

Percutaneous interventional procedures under image guidance, such as biopsy, ethanol injection therapy, and radiofrequency ablation play important roles in the management of hepatocellular carcinomas. Although uncommon, the procedures may result in tumor implantation along the needle tract, which is a major delayed complication. Implanted tumors usually appear as one or a few, round or oval-shaped, enhancing nodules along the needle tract on CT, from the intraperitoneum through the intercostal or abdominal muscles to the subcutaneous or cutaneous tissues. Radiologists should understand the mechanisms and risk factors of needle tract implantation, minimize this complication, and also pay attention to the presence of implanted tumors along the needle tract during follow-up.

Percutaneous Ethanol Injection in Autonomous Functioning Thyroid Nodules and Complex Cysts: Five Years' Experience / 대한내분비학회지

BACKGROUND: Percutaneous ethanol injection therapy (PEI) performed with ultrasonography guidance has recently been used in cases of autonomous functioning thyroid nodules (AFTN) and benign complex cysts. We performed this study to analyze the effects of PEI on AFTN and benign complex cysts. METHEODS: From September 1995 to September 2000, we performed PEI on 456 outpatients (47 men and 409 women, mean age 42.4+/-11.8 years) with AFTN or benign complex cysts. All cases were subjected to fine needle aspirations (FNA) by ultrasonography-guidance if necessary. FNA was performed at least twice with results of colloid nodule in cases of complex cysts. For AFTN, cases with FNA results of follicular neoplasm were also included. After PEI on AFTN, patients were classified into three response groups: complete response as judged by our new criteria (CR, normalization of TSH and free T4, disappearance of hot nodule on thyroid scan) along with the old criteria of previous studies (normalization of TSH and free T4, recovery of suppressed extranodular tissue on thyroid scan), partial response (PR, normalized free T4 but suppressed TSH, persistent hot nodule despite recovery in suppressed extranodular tissue) and no response (no change of hot nodule). Complex cysts were classified into three groups in accordance with volume reduction after PEI: complete response (CR, above 90% of volume reduction), partial response (PR, 50~89%) and no response (below 50%). RESULTS: Overall pre-treatment volumes were 15.3+/-12.1 mL and post-treatment volumes were 2.8+/-2.9 mL, with 66.4+/-19.9% of volume reductions in AFTN and complex cysts. Volume reductions were 71.5+/-18.0% in AFTN, and 66.1+/-15.0% in complex cysts. In 24 cases of AFTN, responses satisfying the previous criteria were 14 (58.3%) of CR, 6 (25.0%) of PR, and 4 (16.7%) of no response. However, by the new criteria there were 1 (4.2%) of CR, 10 (41.6%) of PR, and 13 (54.2%) of no response. In 432 cases of complex cysts, CR was observed in 82 (19.0%), PR in 261 (60.4%) and no response in 89 (20.6%). The volume reductions in complex cysts with pre-treatment volume larger than 15 mL were higher than those of groups with smaller volumes (p<0.001). Pre-treatment volumes were not correlated with post-treatment volumes, nor with volume reductions. Volume reductions were not correlated with the amounts of injected ethanol. Mild and transient complications were observed in 41 cases (9.0%) during PEI, consisting of transient neck pain (n=36, 7.9%), transient unilateral vocal cord palsy (n=3, 0.7%), intracavitary hemorrhage (n=1, 0.2%), and transient hypotension (n=1, 0.2%). CONCLUSION: Our data suggest that the efficacy of PEI on AFTN is temporary and does not usually induce long-term complete remissions. In complex cysts, however, PEI may have potential as an additive treatment modality to thyroid hormone suppressive therapy

Effectiveness of Percutaneous Ethanol Injection in Benign Cold Thyroid Nodules: Five Years' Experience / 대한내분비학회지

BACKGROUND: Percutaneous ethanol injection therapy (PEI) which is performed with the guidance of ultrasonography has recently been used in patient who had benign cold thyroid nodules. We performed this study to analyze the long-term effects of PEI on benign cold thyroid nodules. METHOD: From September 1995 to September 2000, we treated 198 outpatients (12 men and 186 women, who had a mean age of 40.8 years, with a range of 15-71) who had benign cold thyroid nodules at the Asan Medical Center. The PEI was performed on 141 patients who had solitary nodules (SN) and on 57 patients who had prominent nodules or Questionable or typing error? multiple nodules (MN). All patients had fine needle aspirations (FNAs) at least twice which resulted in a diagnosis of the presence of a colloid nodule. Thyroid hormone was given to all patients along with TSH measurements. The thyroid hormone dose was titrated to correspond to TSH level of a low normal range. These patients were followed up for mean period of 37.6 months (range 18-60). Patients who were treated with PEI were classified into three groups according to their volume reduction: a complete response (CR, which was above 90% in volume reduction), a partial response (PR, which was a 50-89%) reduction and No Response (which was below 50% or an increased size) groups. RESULTS: The overall pre-treatment volumes of the nodules were 15.7+/-19.8 mL. The overall post-treatment volumes were 2.4+/-2.6 mL and consisted of volume reductions of 70.1+/-17.1%. The results of PEI for all of the patients were: a complete reduction (CR) in 34 cases (17.2%), a partial reduction (PR) in 142 cases (71.7%) and No Response in 22 patients (11.1%). In 141 patients in the SN group, in which there was a mean follow-up duration of 36.7+/-11.2 months, the volume reductions were 68.3+/-18.8%. CR was observed in 20 patients (14.2%), PR in 103 (73.0%) and No Response in 18 (12.8%). In twenty-two of the SN patients (22/141, 15.6%) we were able to discontinue the thyroid hormone suppressive therapy because those nodules had markedly decreased in volume after PEI without any further increase of nodule size during the follow-up period. In 57 patients in the MN group, over a mean follow-up durations of 37.1+/-11.4 months, the volume reductions were 74.3+/-12.1%. CR was observed in 14 patients (24.6%), PR in 39 (68.4%) and No Response occurred in 4 (7.0%). During the follow-up period after PEI, further volume reductions were observed for 36 months after thyroid hormone suppressive therapy in the Response Group. Differences in volume reductions between the SN and MN groups were not statistically significant but the volume reductions in patients who had a pre-treatment volume larger than 15 mL were higher than those in the smaller group (p<0.001). In the cases of the SN and MN groups, volume reductions did not correlate with either the amount of injected ethanol or the pre-treatment volumes, but the pre-treatment volumes correlated with post-treatment volumes in the patients who had SN (p<0.001, r=0.411) and MN (p<0.001, r=0.729). We observed mild, but transient complications in 32 patients (16.2%) during PEI which included a transient neck pain (n=27, 13.6%), a transient unilateral vocal cord palsy (n=4, 2.0%), and an abscess formation (n=1, 0.5%) which was cured. CONCLUSION: These results suggest that PEI is a feasible adjunctive therapy to use in thyroid hormone suppressive therapy for benign cold thyroid nodules