Percutaneous management of hepatocellular carcinoma: Patient selection for percutaneous alcohol injection alone or combined with arterial chemoembolization

The purpose of our study was to assess the efficacy of percutaneous ethanol injection (PEI) alone or in combination with transarterial chemoembolization (TACE) for patients with hepatocellular carcinoma (HCC) not eligible for surgery. From January 1989 to December 1993, 46 patients (40 men, 6 women) with cirrhosis and histologically proven HCC were treated percutaneously. Twenty-six patients (56.5%) with single tumours smaller than 5 cm were treated with PEI alone. Twenty patients (43.5%) with multiple tumours or a single HCC 5 cm or larger were treated with both PEI and TACE. Treatment results were evaluated by length of survival and findings on follow-up imaging studies. Survival rates in the group treated with PEI were 81% at 1 year, 70% at 2 years, and 56% at 3 years. In the group treated with PEI and TACE, survival was 79% at 1 year, 55% at 2 years, and 46% at 3 years. Treatment failed to control HCC in 16 patients (34.8%). There were no treatment-related major complications or deaths. As a means of palliative management, PEI is effective for solitary HCC smaller than 5 cm, while PEI and TACE in combination are effective for larger or multiple tumours.