Treatment of hepatocellular carcinoma by percutaneous tumor ablation methods: Ethanol injection therapy and radiofrequency ablation

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In Japan, ∼30,000 patients died of hepatocellular carcinoma (HCC) in 2003. Ten percent had hepatitis B virus infection and 80% had hepatitis C virus (HCV) infection, indicating that viral hepatitis accounted for >90% of cases of HCC. In comparison, only 3% (1.5%, hepatitis B virus; 1.5%, HCV) of the general population is infected with these viruses. We treated 1238 patients between 1992 and the end of 2003 by means of percutaneous tumor ablation (PTA): 524 patients, by percutaneous ethanol injection therapy (PEIT); 85 patients, by percutaneous microwave coagulation therapy; and 629 patients, by radiofrequency ablation (RFA). Three-, 5-, 7-, and 10-year survival rates of the 1238 patients were 69%, 50%, 34%, and 19%, respectively. When limited to tumors ≤3 cm in diameter and ≤3 in number of cancer nodules (3-3 rule), 5-year survival rates reached 64.7% for PEIT. However, to achieve a 40% survival rate in year 5 after PEIT, the indication for treatment can be expanded to a 4 (size)-3 (number) rule or 5 (size)-1 (number) rule. The recent introduction of RFA may further change the rules. HCV-related HCC generally develops on the background of advanced fibrosis/cirrhosis. An issue of much concern is that it may subsequently recur in a location other than that of the primary lesion. We initiated a prospective controlled study to evaluate treatment with PTA and interferon. Results suggest that if the virus is eradicated, a 5-year survival rate as high as 80% can be expected.

Section snippets

Patients

This is a single-institute experience. We analyzed clinical features of consecutive patients treated by means of percutaneous tumor ablation (PTA) from 1992 to the end of 2003 at the Department of Gastroenterology, University of Tokyo. The diagnosis of HCC was made by means of imaging modalities, including ultrasound and computed tomography (CT), and confirmed by means of tumor-targeted biopsies. Patients were referred from all over the country, and some were from outside Japan (Figure 1). In

Percutaneous tumor ablation for recurrence

From 1992 to the end of 2003, a total of 1238 patients were treated. Because many patients were treated more than twice, 2780 treatments were given to 1238 patients (Table 1). Thus, on average, 1238 patients underwent PTA on 2.2 occasions (treatments).

Changes in percutaneous tumor ablation procedure

The first percutaneous procedure introduced to treat HCC was the ethanol injection method (Figure 2). After that, PMCT was used in Japan. This method used a large introducing needle (14 G). Then RFA became available as one of the percutaneous

Discussion

To our knowledge, this is the largest series describing medical treatment for HCC by PTA as a single-institution experience. It appears that both the increase in incidence of HCC in Japan and the attraction of patients to our department as a specialized tertiary care center have contributed to that large number (Figure 1). The PTA procedure was performed by 2–3 physicians at 1 time without other comedical staff attending, clearly showing how efficiently these treatments can be performed with

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