Percutaneous cryoablation combined with ethanol injection for unresectable hepatocellular carcinoma / 中华消化杂志

ABSTRACT

Objective To evaluate the effectiveness and safety of percutaneous hepatic cryoablation combined with percutaneous ethanol injection(PEI) for patients with hepatocellular carcinoma (HCC) unsuitable for surgical resection. Methods One hundred and five masses in 65 HCC patients underwent percutaneous hepatic cryoablation. The cryoablation was performed using Argon gas as a cryogen in the Cryocare System. Two freeze thaw cycles were performed, each reaching a temperature of -180 ℃ at the tip of the probe. PEI was given 1 or 2 weeks after cryoablation and then once a week for 4 6 weeks in 36 patients with tumor mass larger than 6 cm in diameter. Absolute alcohol(100%) was slowly injected into periphery zone of cancerous tissues in liver. Results During average 16 months follow up duration (ranging 5 to 21 months), 32 patients(49.2%) were alive without tumors, and 22 patients (33.8%) were alive with tumor recurrence two had bone metastases, three lung metastases and the remaining 17 tumor recurrences in the liver, of whom only 3 developed at a cryoalbation site. Among 41 patients who had been followed up more than one year, there were 32(78%) patients who were alive with or without tumor recurrence. Eight patients (12.3%) died of tumor recurrence. Three patients(4.6%) died of noncancer related causes. Among 43 patients who had undergone CT scan, 38 ( 88.4% ) had a shrinkage of tumor mass. Among 22 patients who had received biopsies of cryoablated tumor mass, all but one biopsy showed necrotic or scar tissues. Serum AFP in 91.3% of the patients whose serum AFP had increased before cryoablation returned to normal or nearly normal levels during postoperative 3 6 months. Complications of cryoablation included liver capsular cracking in one patient, transient thrombocytopenia in 4 patients and asymptomatic right sided pleural effusions in 2 patients. Two patients developed liver abscess at the previous cryoablation sites after postoperative 2 and 4 months respectively and recovered after the treatment with antibiotics and drainage. Conclusions Percutaneous cryoablation may offer a safe and effective option for patients with HCC that cannot be surgically removed.