Vallone Paolo, Catalano Orlando, Izzo Francesco, Siani Alfredo
Department of Radiology, National Cancer Institute, Fondazione Pascale, via Semmola, 80131 Naples, Italy.
Cardiovasc Intervent Radiol. 2006 Jul-Aug;29(4):544-51. doi: 10.1007/s00270-005-0173-2.
Optimal treatment of large-sized hepatocellular carcinoma (HCC) is still debated, because percutaneous ablation therapies alone do not always achieve complete necrosis.
To report our experience in the treatment of patients with HCC larger than 4 cm in diameter by combined percutaneous ethanol injection and radiofrequency thermal ablation.
In a 5-year period there were 40 consecutive patients meeting the inclusion criteria (24 men and 16 women; age range 41-72 years, mean 58 years). These subjects had a single HCC larger than 4 cm. Twelve subjects also had one or two additional nodules smaller than 4 cm (mean 1.2 nodules per patient). Patients were submitted to one to three sessions consisting of ethanol injection at two opposite tumor poles (mean 12 ml) and then of radiofrequency application through one or two electrodes placed at the tumor center (mean treatment duration 30 min).
Complete necrosis was obtained in all cases with one to three sessions (mean 1.3 sessions per patient). All patients experienced pain and fever but one only subject had a major complication requiring treatment (abscess development and fistulization). Overall follow-up was 7-69 months. Two patients showed local recurrence and 9 developed new etherotopic HCC nodules. Seven subjects died during follow-up while 33 were free from recurrence 8-69 months after treatment.
A combination of ethanol injection and radiofrequency ablation is effective in the treatment of large HCC.
大尺寸肝细胞癌（HCC）的最佳治疗方案仍存在争议，因为单纯经皮消融治疗并不总能实现完全坏死。
报告我们采用经皮乙醇注射与射频热消融联合治疗直径大于4 cm的HCC患者的经验。
在5年期间，连续有40例患者符合纳入标准（男性24例，女性16例；年龄范围41 - 72岁，平均58岁）。这些患者患有单个直径大于4 cm的HCC。12例患者还伴有1个或2个直径小于4 cm的额外结节（平均每位患者1.2个结节）。患者接受1至3个疗程的治疗，包括在肿瘤相对的两极注射乙醇（平均12 ml），然后通过置于肿瘤中心的1个或2个电极进行射频治疗（平均治疗持续时间30分钟）。
所有病例经1至3个疗程治疗后均实现完全坏死（平均每位患者1.3个疗程）。所有患者均经历疼痛和发热，但仅有1例患者出现需要治疗的严重并发症（脓肿形成和瘘管形成）。总体随访时间为7至69个月。2例患者出现局部复发，9例患者出现新的异位HCC结节。7例患者在随访期间死亡，33例患者在治疗后8至69个月无复发。
乙醇注射与射频消融联合治疗大尺寸HCC有效。
