Combined treatment of large hepatocellular carcinoma with transcatheter arterial chemoembolization and percutaneous ethanol injection with a multipronged needle: experimental and clinical investigation
| Autor: | Yu Takahashi, Hideto Umehara, Toshihito Seki, Kozo Ikeda, Ryosuke Inokuchi, Rinako Kawamura, Toshiki Asayama, Masayuki Sakao, Takashi Yamaguchi, Kazuichi Okazaki, Riccardo Lencioni |
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| Jazyk: | angličtina |
| Rok vydání: | 2012 |
| Předmět: |
Male
medicine.medical_specialty Carcinoma Hepatocellular Swine medicine.medical_treatment Combined treatment Clinical investigation Carcinoma medicine Animals Humans Radiology Nuclear Medicine and imaging Chemoembolization Therapeutic Transcatheter arterial chemoembolization Aged Ultrasonography Aged 80 and over Ethanol business.industry Liver Neoplasms medicine.disease digestive system diseases Clinical trial Experimental animal Treatment Outcome Liver Needles Hepatocellular carcinoma Female Radiology Percutaneous ethanol injection Neoplasm Recurrence Local Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Popis: | This study was designed to evaluate the usefulness of percutaneous ethanol injection (PEI) with a multipronged needle for the treatment of large hepatocellular carcinoma (HCC). An experimental animal study and a clinical investigation were performed.In the experimental study, 20 ml of 99.5% ethanol was injected into porcine liver in vivo with a multipronged needle (n = 5) or a straight needle (n = 5), and the volumes of coagulation necrosis were compared. In the clinical investigation, PEI was performed in 17 patients (10 men, 7 women; mean age 73.4 ± 6.7 years) with single, large HCC (mean tumor diameter, 47.2 ± 11.5 mm; range, 32-70 mm) by using a multipronged needle. Fifteen of 17 patients received transarterial chemoembolization (TACE) before PEI.The volume of coagulation in porcine liver in vivo was significantly increased with the multipronged needle compared with the straight needle (longest perpendicular diameters, 34.2 ± 3.6 mm × 30.2 ± 3.6 mm vs. 22.6 ± 2.5 mm × 19 ± 2.2 mm, respectively; P0.05). In the clinical trial, initial complete response (CR) of the tumor was achieved in 17 of 17 patients, 7 of whom required two PEI sessions. During the follow-up, local recurrence was detected in 4 of 17 patients at 3-19 months after the procedure, for a rate of sustained local CR of 76%. No major complication occurred.Use of a multipronged needle substantially increases the volume of coagulation in vivo with respect to the conventional PEI technique. Combined TACE and PEI with multipronged needles is a safe and effective option for percutaneous treatment of single, large HCC. |
| Databáze: | OpenAIRE |
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