Percutaneous ethanol injection therapy for hepatocellular carcinoma: a histopathologic study

Article Abstract:

Hepatocellular carcinoma is a form of liver cancer and, although it is not quite as predominant in the US, is one of the most common cancers worldwide. Generally, the prognosis is poor. Hepatocellular carcinoma often occurs in patients with liver cirrhosis and surgery is often not possible for these patients, even when the cancer is in an early stage. A relatively new treatment for hepatocellular carcinoma is the injection of ethanol directly into the cancer. Ethanol, the form of alcohol that may be ingested, can kill living tissues when it is in sufficient concentrations. The injection of ethanol has become practical only as a result of the development of ultrasonography. This imaging method permits visualizing the cancer while the needle is being inserted, thereby assuring accurate needle placement and the protection of surrounding tissue. Over the past several years, the authors have used this form of treatment for 102 patients. They now report the results of pathological observations on the liver tissue of 18 patients. (In 10 of these cases, however, the patients were also treated with a method which disrupts the blood supply to the tumor mass.) In 14 patients, the pathological specimens became available after surgery; in four cases they became available after the death of the patient. In 13 cases, the cancerous tissue was dead (necrotic) upon examination. In four cases, although 90 percent of the cancerous tissue was dead, some deposits of living cells could be found. Often, the living cancer was separated from the necrotic tissue by tissues that may have served as a physical barrier. In some cases, the deposits of living cancer cells were found around the outskirts of the original tumor. No damage was found to noncancerous tissue outside the tumor itself. These results confirm pathologically the previous reports indicating that ethanol injection may be a useful form of treating liver cancer. The observations also suggest that it may be advantageous to perform several injections into different regions of the cancer to increase the chance that all the cancerous tissue will be destroyed. The authors suggest that ethanol injection may be a useful alternative to surgery in some cases. (Consumer Summary produced by Reliance Medical Information, Inc.)

Alcohol, Ethanol

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Continuous hyperthermic peritoneal perfusion for the treatment of peritoneal dissemination in gastric cancers and subsequent second-look operation

Article Abstract:

When stomach cancer cells have spread into the abdominal cavity, the results are usually fatal within one year. Numerous attempts have been made to improve survival, with little success. Recently a new device has been constructed which eases the treatment of peritoneal dissemination of gastric cancers using hot water in conjunction with chemotherapeutic agents. The device, called a peritoneal cavity expander, or PCE, is an acrylic cylinder, with both ends open and both ends flanged. The flange at one end is attached to the open surgical incision of the patient. The patient, then, literally has an extension of his peritoneal cavity extending up and out of his abdomen. Hot saline solution, to which the chemotherapeutic drugs cisplatin and mitomycin C have been added, is pumped into the cylinder. Although the water is heated to 52 degrees Centigrade, the temperature has dropped to 41-43 degrees by the time the mixture enters the abdomen. The added volume of the cylinder allows the small intestines to float upwards, permitting the hot chemotherapeutic perfusate to enter all the peritoneal nooks and crannies into which it would otherwise diffuse too slowly. The operation using this device was performed on 31 patients, 12 of whom underwent a second-look operation to determine the extent of tumor destruction. Of these 12, 4 had complete response, 1 had partial response, 3 had no change and 4 showed progressive disease. The complete and partial responders had a two-year survival rate of 50 percent, which compares favorably with the zero percent of the non-responding patients. One complication observed was renal (kidney) failure, which is believed to have resulted from the reuptake of peritoneal liquids after the operation, causing excessive edema. The appropriate use of diuretics is crucial at this time. The use of hyperthermic peritoneal perfusion probably has both direct effects of the tumor cells themselves and an enhancement of the activity of the chemotherapeutic agents, and more widespread use of the technique is suggested. (Consumer Summary produced by Reliance Medical Information, Inc.)

Surgery, Cancer, Chemotherapy, Stomach cancer, Irrigation (Medicine), Peritoneal cavity

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Radiofrequency thermotherapy for malignant liver tumors

Article Abstract:

Just as microwaves may be used to quickly heat up a slice of pizza, so radiofrequency energy may be used to heat up any electrical conductor, including human tissue. This method of applying heat may used in the treatment of cancer; in general heating, or thermotherapy, is combined with chemotherapy or radiotherapy for maximum effect. Experience with the use of thermotherapy in treating liver cancer has shown it to be a promising development for the treatment of liver cancers, which are not amenable to surgery. A total of 67 liver cancers were treated and evaluated: 41 hepatocellular carcinomas, 6 cholangiocarcinomas, and 20 metastatic tumors. For the hepatocellular carcinomas, a 28 percent response was seen with thermotherapy and chemotherapy, 86 percent for thermotherapy with radiotherapy, and 33 percent with thermotherapy and artificial embolization of the hepatic artery. The responses of the non-hepatocellular carcinomas was different; 11 percent responded to thermotherapy and chemotherapy, 33 percent to thermotherapy and radiotherapy, and 89 percent for thermotherapy and embolization. Although the results are promising, the number of liver cancer patients treated is not yet large enough to determine if thermotherapy has any long-lasting therapeutic effects. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Hyperthermia treatment systems (Medical care), Hyperthermia treatment equipment

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