Comparison between percutaneous acetic acid injection and percutaneous ethanol injection for small hepatocellular carcinoma

ABSTRACT

To assess whether ultrasound-guided percutaneous acetic acid injection is superior to pencutaneous ethanol injection in the treatment of small hepatocellular carcinoma [HCC], 60 patients with one to four HCCs smaller than 3cm were entered onto a randomized controlled trial. Thirty-one and 29 patients, respectively, were treated by percutaneous acetic acid injection using 50% acetic acid or by percutaneous ethanol injection using absolute ethanol. There were no significant difference in age, sex ratio, child-Pugh class, liver function tests, alpha-fetoprotein levels, size of tumors, or number of tumors between the two groups. When there was no evidence of viable HCC from biopsy and CT, the treatment was considered successful and was discontinued. All original tumors were treated successfully by either therapy. However, 9.6% of patients treated with percutaneous acetic acid injection and 34.4% of those treated with percutaneous ethanol injection developed a local recurrence [P<0.001] during the treatment courses. The 1- and 2- year local recurrence rates were 3.5% and 10.7% in percutaneous acetic acid injection, while they were 26.3% and 42.1% in percutaneous ethanol injection [P<0.05]. Also, the I- and 2-year survival rates were 100% and 84.2% in percutaneous acetic acid injection, and 89.2% and 63.1% in percutaneous ethanol injection [P<0.05]. In conclusion, percutaneous acetic acid injection is superior to percutaneous ethanol injection in the treatment of small HCC