PEIT Improves Survival Rates in Hepatocellular Carcinoma

ORLANDO—At the Digestive Disease Week meeting, University of Tokyo researchers reported on the largest single-institution study of the use of percutaneous ethanol injection therapy (PEIT) in hepatocellular carcinoma (HCC). The research group studied 849 patients hospitalized for HCC at their institution between 1985 and 1997.

Although in the West, HCC occurs less often than metastatic liver disease, it is an important cause of death in many areas of Africa and Asia.

In an interview, University of Tokyo gastroenterologist Shuichiro Shiina, MD, said that HCC accounts for 95% of cases of primary liver cancer. “In Japan, 80% of liver cancer patients have cirrhosis,” Dr. Shiina said. “Seven percent of cirrhosis patients develop cancer within a year, and within 5 years, one third of all cirrhosis patients have cancer. Cirrhosis destroys so much of the liver that not much tissue can be removed to address the HCC. Furthermore, HCC often recurs even after ‘curative’ surgical resection.”

European and Japanese physicians have long employed PEIT to treat HCC. It involves the injection of ethanol through the skin and into the liver under the guidance of either computed tomography (CT) or ultrasound, usually the latter. The injections are repeated until the lesions are obliterated.

The researchers performed PEIT on 756 of the 849 HCC patients, who ranged in age from 35 to 87 years. PEIT was the sole treatment in 594 cases (79%). The remaining PEIT patients also underwent transcatheter arterial embolization.

Survival rates of all 756 PEIT patients at 1, 3, 5, and 10 years were 89%, 64%, 39%, and 18%, respectively. In the 349 patients who had three or fewer lesions (all of which were 3 cm or less in diameter), survival rates were higher: 93%, 74%, 47%, and 26%, respectively. In the 594 patients in whom all lesions were treated by PEIT, survival rates were 93%, 72%, 47%, and 24%, respectively.

“The Tokyo group no longer employs surgical resection for HCC patients,” Dr. Shiina said. “We repeat the PEIT injections until the tumor is totally destroyed. The median number of treatments we use is about six or seven.” Dr. Shiina added that side effects include fever, transient pain, and a feeling of alcohol intoxication.