Small hepatocellular carcinoma: treatment with US-guided intratumoral injection of acetic acid.

Abstract

To assess the efficacy of ultrasound-guided percutaneous acetic acid injection (PAI) in the treatment of hepatocellular carcinoma (HCC). Results of a preliminary study in rats showed that the effectiveness of acetic acid in the destruction of hepatocytes plateaued at a concentration of 50%. Thus, PAI with 50% acetic acid was performed in 25 patients with solitary HCCs 3 cm or less in diameter. The viability of tumor cells after PAI was examined by means of contrast material-enhanced computed tomography (CT) and fine-needle biopsy in all patients. Two patients underwent partial hepatic resection. No clinically significant complications occurred in 82 treatment sessions. All lesions became smaller after a mean of 23 months +/- 8 (standard deviation) of follow-up. There was no evidence of viable HCC at follow-up biopsy and CT. Two HCCs obtained by means of resection showed complete necrosis. The 1-year survival rate among 23 patients who did not undergo surgical treatment was 100%; the 2-year survival rate was 92%. PAI may prove to be an effective therapy for small HCC.