Ultrasound-guided percutaneous ethanol injection: first choice for treatment of hepatocellular carcinoma in the elderly

Summary aneous ethanol injection (PEI) under ultrasound guidance has recently been proposed as a new therapeutic approach for patients with liver cirrhosis (LC) and hepatocellular carcinoma (HCC). HCC is more frequently observed in elderly subjects. We treated 59 patients (44 males and 15 females, mean age 66 years, age-range 54–77 years). Forty-six patients were in Child A, 12 in Child B and 1 in Child C class. Thirty-nine patients had a single lesion up to 5 cm size; 2 had a single lesion larger than 5 cm, and 18 had 2 or 3 lesions, each smaller than 4 cm. The survival rates after 1, 2, 3 and 4 years for all patients were 92, 73, 54 and 54 %, respectively; while for those with only a single lesion amounted to 94, 85, 63, and 63 %, for the same years. In this latter group, the survival rates at 1 and 2 years were significantly higher in subjects in the Child A class, than in those who were in Child B and C classes (100 and 95 %, against 79 and 63 %, respectively, p < 0.05). In the group of patients with multiple lesions the survival rates were 89, 57 and 42 % at 1 , 2 and 3 years, respectively. We did not have any lethal complications during the procedure of PEI, and only minor complications occurred in 6 patients. During the follow-up, 21 patients developed new lesions, and 6 patients had small local recurrences which were possibly retreated. In conclusion, PEI is a safe and efficient alternative therapy for the management of HCC in LC in elderly subjects.