Combination therapy of transcatheter chemoembolization and percutaneous ethanol injection therapy for unresectable hepatocellular carcinoma.

The therapeutic effectiveness of a combination therapy--pretreatment with transcatheter arterial chemoembolization (TACE) followed by percutaneous ethanol injection (PEI) therapy--for large (> 3 cm in diameter) unresectable hepatocellular carcinoma (HCC) was compared with that of TACE alone. PEI therapy was performed in 24 cases of unresectable HCC that had previously been treated with TACE using doxorubicin 30-60 mg or epirubicin 50-90 mg. In all, 2-10 ml of 90% ethanol mixed with carbocaine was repeatedly injected through a 21-gauge, closed-end needle (PEIT needle) for a median of 3.6 injections and 31.1 ml of ethanol. As adverse effects, transient localized pain and a burning sensation were observed in 75.0% of the cases; fever, in 66.7%; and transient hypotension, in two cases. A small unresectable tumor is a good indication for PEI therapy. In cases with a larger tumor, i.e., measuring more than 3 cm in diameter, or multiple tumors, the 1-year survival rate obtained with this combination therapy, i.e., TACE and PEI, was 87.0%, and the 2-year survival rate was 65.2%. These rates were greater than those obtained with TACE alone. Accordingly, additional PEI therapy was effective for larger tumors and multiple tumors previously treated with TACE.