Clinical Management of Hepatocellular Carcinoma. Conclusions of the Barcelona-2000 EASL Conference

There is great geographical variation in the distribution of hepatocellular carcinoma (HCC), with the majority of all cases worldwide found in the Asia–Pacific region, where HCC is one of the leading public health problems. Since the “Toward Revision of the Asian Pacific Association for the Study of the Liver (APASL) HCC Guidelines” meeting held at the 25th annual conference of the APASL in Tokyo, the newest guidelines for the treatment of HCC published by the APASL has been discussed. This latest guidelines recommend evidence-based management of HCC and are considered suitable for universal use in the Asia–Pacific region, which has a diversity of medical environments.

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Asia–Pacific clinical practice guidelines on the management of hepatocellular carcinoma: a 2017 update

PURPOSE: To compare the effectiveness of radio-frequency (RF) ablation with that of percutaneous ethanol injection in the treatment of small hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Eighty-six patients with 112 small (≤3-cm-diameter) HCCs underwent RF ablation (42 patients with 52 tumors) or percutaneous ethanol injection (44 patients with 60 tumors). Therapeutic efficacy was evaluated with dual-phase spiral computed tomography performed at least 4 months after treatment. RESULTS: Complete necrosis was achieved in 47 of 52 tumors with RF ablation (90%) and in 48 of 60 tumors with percutaneous ethanol injection (80%). These results were obtained with an average of 1.2 sessions per tumor with RF ablation and 4.8 sessions per tumor with percutaneous ethanol injection. One major complication (hemothorax that required drainage) and four minor complications (intraperitoneal bleeding, hemobilia, pleural effusion, cholecystitis) occurred in patients treated with RF ablation; no complications occurre...

Small Hepatocellular Carcinoma: Treatment with Radio-frequency Ablation versus Ethanol Injection

Small Hepatocellular Carcinoma: Treatment with Radio-frequency Ablation

Introduction
The Asian Pacific Association for the Study of the Liver (APASL) convened an international working party on the management of hepatocellular carcinoma (HCC) in December 2008 to develop consensus recommendations.

Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma.

Fourteen lesions (nine hepatocellular carcinomas, four hepatic metastases from gastric carcinoma, and one peritoneal metastasis from transitional cell carcinoma) in 12 patients were treated with percutaneous injection of 95% ethyl alcohol under guidance with ultrasound. Requirements for this procedure included inadequate response to conventional treatment or refusal of surgery, easy identification of the tumor with sonography, and a tumor diameter less than 4 cm. Three to nine administrations (75 in all) were performed for each lesion according to its size and to the results of the fine needle biopsy. All lesions had posttreatment sonographic structural changes of fibronecrotic degeneration. All lesions less than 3.2 cm in diameter (11 cases) that underwent the final fine needle biopsy were negative for malignant cells and had volume reductions up to 100%. No biochemical changes or untoward clinical sequelae were detected. Percutaneous intratumoral alcohol injection is inexpensive, easy to perform, and po...

US-guided percutaneous alcohol injection of small hepatic and abdominal tumors.

Twenty-three patients with hepatocellular carcinoma less than 4.5 cm in diameter (32 lesions) were treated with a percutaneous injection of ethyl alcohol performed with ultrasound (US) guidance. No complications or sequelae occurred after 271 treatments. All lesions were smaller after 6-27 months follow-up. No evidence of hepatocellular carcinoma was present at fine-needle biopsy or contrast material-enhanced computed tomography (CT). No viable tumor cells were detected in four patients who subsequently underwent surgery. The 1-year survival rate of 12 patients was 91.7%. From these data, it can be concluded that percutaneous alcohol injection (PAI) is an appropriate first-line treatment for patients with small hepatocellular carcinoma lesions who are poor surgical risks. Given the risk of new nodular lesions occurring on resected livers and the risk of perioperative mortality, PAI might even be considered an alternative to surgery.

Small hepatocellular carcinoma: percutaneous alcohol injection--results in 23 patients.

The local and systemic effects, as well as the repair mechanisms, of sterile absolute ethyl alcohol injection were evaluated at a range of doses (0.1-2.0 mL/kg body weight) in rabbit liver in order to confirm the feasibility and safety of local treatment of tumours in man. Saline injection was used in the control animals. The animals were killed at varying intervals (range: 1-30 days after injection), and the liver was studied by gross and microscopic examination. The ethyl alcohol injection was well tolerated and did not induce significant systemic side-effects. All doses could induce necrosis and none proved to be lethal. The alcohol injection produced an area of coagulation necrosis, the size of which appeared to be dose-related, and which was surrounded by granulation tissue, gradually repairing the necrotic lesion; the adjacent tissue was intact, or had signs of mild steatosis. However, at higher doses (1.0 and 2.0 mL/kg bodyweight), necrotic lesions were observed in the liver both near and remote from the site of injection. Fine needle percutaneous alcohol injection is effective in producing necrotic lesions which appear to be dose-related; at higher doses, however, an unpredictable intrahepatic diffusion may occur.

F. Monti

Papers

US-guided percutaneous alcohol injection of small hepatic and abdominal tumors.

Small hepatocellular carcinoma: percutaneous alcohol injection--results in 23 patients.

Morphological and biochemical effects of intrahepatic alcohol injection in the rabbit.

Comparative evaluation of an intestinal perfusion technique and ultrasonography for monitoring gallbladder motor function