Prognosis of small hepatocellular carcinoma (less than 3 cm) after percutaneous acetic acid injection: Study of 91 cases

✍ Scribed by K Ohnishi; F Nomura; S Ito; K Fujiwara

• Publisher: John Wiley and Sons
• Year: 1996
• Tongue: English
• Weight: 408 KB
• Volume: 23
• Category: Article
• ISSN: 0270-9139
• DOI: 10.1002/hep.510230509

✦ Synopsis

To assess the efficacy of ultrasound (US)-guided per-caused by underlying cirrhosis [4][5][6] or very few donors for cutaneous acetic acid (in concentrations of 15%, 20%, transplantation. [7][8][9] 30%, 40%, and 50%) injection for small hepatocellular car-This has prompted the development of other potencinomas (HCCs) for long-term prognosis, percutaneous tially curative therapeutic modalities such as transacetic acid injection using 15% to 50% acetic acid was catheter hepatic arterial embolization [10][11][12] and ultraperformed in 91 patients with one to four HCCs smaller sound (US)-guided percutaneous injection of materials than 3 cm during the past 6.5 years. During the series to kill cancer cells. [13][14][15][16][17][18][19][20][21][22][23][24] Among the latter, percutaneous of treatment sessions for each patient, the same concenethanol injection (PEI) has recently been performed tration of acetic acid was used. All tumors could be for small HCC in many countries. [13][14][15][16][17][18][19][20][21][22][23] In the course of treated successfully with percutaneous acetic acid injecdevelopment of US-guided percutaneous injection of a tion despite the differences in acetic acid concentration used. The number of treatment sessions to treat similar material to kill cancer cells, we took up acetic acid that size of tumor was less when the higher concentration of has a strong ability to penetrate cells with a capability acetic acid was used. No serious complications occurred of dissolving lipids and extracting collagen. 25 The net as a direct sequela to percutaneous acetic acid injection. effect is cell kill.

None of the tumor treated regrew. The 1-, 2-, 3-, 4-, and

In a previous study, we demonstrated in rats that 5-year survival rates for 91 patients were 95%, 87%, 80%, the capability of acetic acid to necrotize hepatocytes 63%, and 49%, respectively. The 1-, 2-, 3-, 4-, and 5-year increased with an increase of its concentration until its cancer-free survival rates of these patients were 83%, killing effect plateaued at 50%, and that its capability 54%, 50%, 37%, and 29%, respectively. Both liver function at 15% was equal to or greater than a capability of and size of tumor affected both survival rate and cancerabsolute alcohol to necrotize hepatocytes. 26,27 Based on free survival rate significantly, but the number of tumors did not. The concentration of acetic acid did not these results, we developed a US-guided method called affect the survival rate. Percutaneous acetic acid using percutaneous acetic acid injection (PAI), using 15%, 15% to 50% acetic acid will be effective therapy for small 20%, 30%, 40%, and 50% acetic acid solutions; we have HCCs for long-term prognosis. (HEPATOLOGY 1996;23:994adopted it since 1988 as part of a multidisciplinary 1002.) treatment for HCCs smaller than 3 cm and small in number (fewer than four). 26,27 We now report an analysis of long-term prognosis for 91 patients with one to Early detection plans for hepatocellular carcinoma four HCCs smaller than 3 cm who were treated with (HCC) are expected to increase the number of small PAI using 15% to 50% acetic acid during the past 6.5 HCCs detected for surgical resection in endemic reyears. gions. 1-3 However, surgical resection or orthotopic liver transplantation is possible in a much smaller propor-

PATIENTS AND METHODS

tion of cases because of impairment of liver function

Ninety-one patients with one to four HCCs smaller than 3 cm in diameter, admitted to