Percutaneous Ethanol Injection to Treat Hepatocellular Carcinoma of 3 cm or Less: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

ZHANG Jinhui ¹ , AHAN Ayifuhan ¹ , ZHANG Rixin ² , CAO Jun ¹ , XIE Fei ¹ , SUN Yuliang ³ ,  TAI Qinwen ¹

1. Department of Liver Transplant & Celoscope Surgery, The Frist Affiliated Hosipital of Xinjiang Medical University, Urumqi 830054, China;2. General Sugery,The Central Hospital of Wuhan ,Wuhan 430010,China;3. Department of Stomatology, The Frist Affiliated Hosipital of Xinjiang Medical University, Urumqi 830054, China;

Corresponding author：

TAI Qinwen, Email: taiqinwen@163.com

Keywords：

Ethanol injection; Hepatocellular carcinoma; Efficacy; Safety; Systematic review

DOI：

10.7507/1672-2531.20090123

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective 　To evaluate the efficacy and safety of percutaneous ethanol injection for hepatocellular carcinomas of 3 cm or less.
Methods 　Randomized controlled trials (RCTs) from the Cochrane Controlled Trials Register (Cochrane Library issue 2, 2008), PubMed (1966 to 2008), EMbase (1966 to 2008), CBMdisc (1978 to 2008), and CNKI (1979 to 2008) were electronically searched. We hand searched related published and unpublished data and their references. Randomized controlled trials of percutaneous ethanol injection to treat hepatocellular carcinomas of 3 cm or less were included. Data were extracted and evaluated by two reviewers independently using a designed extraction form. RevMan 4.2.10 software was used for data analysis.
Results 　Seven RCTs involving 891 patients were included. We conducted subgroup analyses based on outcome measures and interventions. Compared with RFA, for treatment of hepatocellular carcinomas of 3 cm or less, PEI showed statistical differences in one and three-year survival rates and one and three-year local recurrence rates after treatment(RR=0.95, 95%CI 0.91 to 1.00; RR=0.80, 95%CI 0.71 to 0.91; RR=2.18, 95%CI 1.11 to 4.30; RR=2.59, 95%CI 1.55 to 4.32). As for hepatocellular carcinomas of 2-3 cm, PEI showed statistical difference in three year cancer free survival rates after treatment (RR=0.47, 95%CI 0.24 to 0.93) .
Conclusion 　Considering the relatively poor quality of most included trials and small sample size, insufficient evidence was obtained in this systematic review. Therefore, more randomized controlled trials with high quality are still needed to assess and verify the efficacy and safety of this treatment.

Citation： ZHANG Jinhui,AHAN Ayifuhan,ZHANG Rixin,CAO Jun,XIE Fei,SUN Yuliang,TAI Qinwen. Percutaneous Ethanol Injection to Treat Hepatocellular Carcinoma of 3 cm or Less: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2009, 09(6): 695-704. doi: 10.7507/1672-2531.20090123 Copy

1.	Jemal A, Murray T, Ward E, et al. Cancer statistics. CA Cancer J Clin, 2005, 55(1): 10-30.
2.	Bruix J, Sherman M. Management of hepatocellular carcinoma. Hepatology, 2005, 42(5): 1208-1236.
3.	Sigura N, Takara K, Ohto M, et al. Percutaneous intratumoral injection of ethanol under ultrasound imaging for treatment of small hepatocellular carcinoma. Acta Hepatol Jpn, 1983, 24: 920-925.
4.	Nimmaanrat S, Prechawai C, Tanomkiat W. Anesthetic techniques and complications in patients with hepatocellular carcinoma undergoing percutaneous ethanol injection. Minerva Anestesiol, 2007, 73(6): 333-337.
5.	Castroagudín JF, Delgado M, Villanueva A, et al. Safety of percutaneous ethanol injection as neoadjuvant therapy for hepatocellular carcinoma in waiting list liver transplant candidates. Transplant Proc, 2005, 37(9): 3871-3873.
6.	Liao CS, Yang KC, Yen AM, et al. Remission, relapse, and metastasis/death of small hepatocellular carcinoma treated with percutaneous ethanol injection. Cancer J, 2006, 12(3): 175-177.
7.	Livraghi T, Giorgio A, Marin G, et al. Hepatocellular carcinoma and cirrhosis in 746 patients: long-term results of percutaneous ethanol injection. Radiology, 1995, 197(1): 101-108.
8.	Gournay J, Tchuenbou J, Richou C, et al. Percutaneous ethanol injection vs. resection in patients with small single hepatocellular carcinoma: A retrospective case-control study with cost analysis. Aliment Pharmacol Ther, 2002, 16(8): 1529-1538.
9.	Daniele B, De Sio I, Izzo F, et al. Hepatic resection and percutaneous ethanol injection as treatments of small hepatocellular carcinoma: a Cancer of the Liver Italian Program (CLIP 08) retrospective case-control study. J Clin Gastroenterol, 2003, 36(1): 63-67.
10.	Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Review of Interventions 4.2.6 [Updated September 2006]. The Cohrane Library, Issue 4, 2006. Chichester, UK: JohnWiley & Sons.Ltd.
11.	Lin SM, Lin CJ, Lin CC, et al. Radiofrequency ablation improves prognosis compared with ethanol injection for hepatocellular carcinoma <or=4cm . Gastroenterology, 2004, 127(6): 1714-1723.
12.	Shiina S, Teratant T, Obi S, et al. A randomized controlled trial of radiofrequency ablation with ethanol injection for small hepatocellular carcinoma. Gastroenterology, 2005, 129(1): 122-130.
13.	Brunell F, Veltri A, Carucctr P, et al. Adiofrequency ablation versus ethanol injection for early hepatocellular carcinoma: A randomized controlled trial. Scandinavian Journal of Gastroenterology, 2008, 43(6): 727-735.
14.	Lin SM, Lin CJ, Lin CC, et al. Randomised controlled trial comparing percutaneous radiofrequency thermal ablation, percutaneous ethanol injection and percutaneous acetic acid injection to treat hepatocellular carcinoma of 3 cm or less. Gut, 2005, 54: 1151-1156.
15.	Ohnishi K, Yoshioka H, Ito S, et al. Prospective randomized controlled trial comparing percutaneous acetic acid injection and percutaneous ethanol injection for small hepatocellular carcinoma. Hepaology, 1998, 27(1): 67-72.
16.	Huang GT, Lee PH, Tsang YM, et al. Percutaneous ethanol injection versus surgical resection for the treatment of small hepatocellular carcinoma. Ann Surg, 2005, 242(1): 36-42.
17.	Zhang YJ, Liang HH, Chen MS, et al. Hepatocellular carcinoma treated with radiofrequency ablation with or without ethanol injection: A Prospective Randomized Trial. Radiology, 2007, 244: 599-607.
18.	陈敏山, 张耀军, 李锦清, 等. 经皮射频消融联合瘤内无水酒精注射与单纯射频消融治疗小肝癌的疗效比较. 中国肿瘤杂志, 2005, 10: 623-625.
19.	Lencioni RA, Allgaier HP, Cioni D, et al. Small hepatocellular carcinoma in cirrhosis:Randomized comparison of radiofrequency thermal ablation versus percutaneous ethanol injection. Radiology, 2003, 228(1): 235-240.
20.	Kurokohchi K, Watanabe S, Masaki T, et al. Combined use of percutaneous ethanol injection and radiofrequency ablation for the effective treatment of hepatocelluar carcinoma. Int J Oncol, 2002, 21(4): 841-846.
21.	Moher D, Sc M. The CONSORT Guidelines: improving the quality of research. Consolidated standards of reporting trials. Interview by Bonnie Horrigan. Altern Ther Health Med, 2002, 8(3): 103-108.

1. Jemal A, Murray T, Ward E, et al. Cancer statistics. CA Cancer J Clin, 2005, 55(1): 10-30.
2. Bruix J, Sherman M. Management of hepatocellular carcinoma. Hepatology, 2005, 42(5): 1208-1236.
3. Sigura N, Takara K, Ohto M, et al. Percutaneous intratumoral injection of ethanol under ultrasound imaging for treatment of small hepatocellular carcinoma. Acta Hepatol Jpn, 1983, 24: 920-925.
4. Nimmaanrat S, Prechawai C, Tanomkiat W. Anesthetic techniques and complications in patients with hepatocellular carcinoma undergoing percutaneous ethanol injection. Minerva Anestesiol, 2007, 73(6): 333-337.
5. Castroagudín JF, Delgado M, Villanueva A, et al. Safety of percutaneous ethanol injection as neoadjuvant therapy for hepatocellular carcinoma in waiting list liver transplant candidates. Transplant Proc, 2005, 37(9): 3871-3873.
6. Liao CS, Yang KC, Yen AM, et al. Remission, relapse, and metastasis/death of small hepatocellular carcinoma treated with percutaneous ethanol injection. Cancer J, 2006, 12(3): 175-177.
7. Livraghi T, Giorgio A, Marin G, et al. Hepatocellular carcinoma and cirrhosis in 746 patients: long-term results of percutaneous ethanol injection. Radiology, 1995, 197(1): 101-108.
8. Gournay J, Tchuenbou J, Richou C, et al. Percutaneous ethanol injection vs. resection in patients with small single hepatocellular carcinoma: A retrospective case-control study with cost analysis. Aliment Pharmacol Ther, 2002, 16(8): 1529-1538.
9. Daniele B, De Sio I, Izzo F, et al. Hepatic resection and percutaneous ethanol injection as treatments of small hepatocellular carcinoma: a Cancer of the Liver Italian Program (CLIP 08) retrospective case-control study. J Clin Gastroenterol, 2003, 36(1): 63-67.
10. Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Review of Interventions 4.2.6 [Updated September 2006]. The Cohrane Library, Issue 4, 2006. Chichester, UK: JohnWiley & Sons.Ltd.
11. Lin SM, Lin CJ, Lin CC, et al. Radiofrequency ablation improves prognosis compared with ethanol injection for hepatocellular carcinoma <or=4cm . Gastroenterology, 2004, 127(6): 1714-1723.
12. Shiina S, Teratant T, Obi S, et al. A randomized controlled trial of radiofrequency ablation with ethanol injection for small hepatocellular carcinoma. Gastroenterology, 2005, 129(1): 122-130.
13. Brunell F, Veltri A, Carucctr P, et al. Adiofrequency ablation versus ethanol injection for early hepatocellular carcinoma: A randomized controlled trial. Scandinavian Journal of Gastroenterology, 2008, 43(6): 727-735.
14. Lin SM, Lin CJ, Lin CC, et al. Randomised controlled trial comparing percutaneous radiofrequency thermal ablation, percutaneous ethanol injection and percutaneous acetic acid injection to treat hepatocellular carcinoma of 3 cm or less. Gut, 2005, 54: 1151-1156.
15. Ohnishi K, Yoshioka H, Ito S, et al. Prospective randomized controlled trial comparing percutaneous acetic acid injection and percutaneous ethanol injection for small hepatocellular carcinoma. Hepaology, 1998, 27(1): 67-72.
16. Huang GT, Lee PH, Tsang YM, et al. Percutaneous ethanol injection versus surgical resection for the treatment of small hepatocellular carcinoma. Ann Surg, 2005, 242(1): 36-42.
17. Zhang YJ, Liang HH, Chen MS, et al. Hepatocellular carcinoma treated with radiofrequency ablation with or without ethanol injection: A Prospective Randomized Trial. Radiology, 2007, 244: 599-607.
18. 陈敏山, 张耀军, 李锦清, 等. 经皮射频消融联合瘤内无水酒精注射与单纯射频消融治疗小肝癌的疗效比较. 中国肿瘤杂志, 2005, 10: 623-625.
19. Lencioni RA, Allgaier HP, Cioni D, et al. Small hepatocellular carcinoma in cirrhosis:Randomized comparison of radiofrequency thermal ablation versus percutaneous ethanol injection. Radiology, 2003, 228(1): 235-240.
20. Kurokohchi K, Watanabe S, Masaki T, et al. Combined use of percutaneous ethanol injection and radiofrequency ablation for the effective treatment of hepatocelluar carcinoma. Int J Oncol, 2002, 21(4): 841-846.
21. Moher D, Sc M. The CONSORT Guidelines: improving the quality of research. Consolidated standards of reporting trials. Interview by Bonnie Horrigan. Altern Ther Health Med, 2002, 8(3): 103-108.

Chinese Journal of Evidence-Based Medicine

Percutaneous Ethanol Injection to Treat Hepatocellular Carcinoma of 3 cm or Less: A Systematic Review

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content