Percutaneous alcohol ablation for liver metastasis

Ultrasound-guided percutaneous alcohol injection (PAI) is used in the treatment of hepatocellular carcinoma for lesions less than 3 to 5 cm in diameter. However, few studies in the literature have evaluated the place of PAI in the treatment of liver metastasis. Alcohol acts by causing coagulative necrosis, followed by the formation of fibrotic and granulomatous tissue and thrombosis of small vessels. The results of the various published studies are similar, with a complete necrosis rate lower than that obtained in hepatocellular carcinoma. Nevertheless, in more than 50% of cases of liver metastasis less than 4 cm in diameter, complete necrosis can be obtained, and PAI would seem to be a reasonable option for the treatment of small metastases of colorectal or mammary origin and for endocrine tumors when surgery is contraindicated. PAI could be a valuable alternative in the treatment of selected small metastases of the liver. However, the new techniques of local tumor destruction (interstitial laser photocoagulation (ILP), cryoablation, radiofrequency thermal ablation, and microwave destruction) will replace PAI for the treatment of liver metastasis in the near future. Copyright 2002, Elsevier Science (USA). All rights reserved.