Alcohol injection, percutaneous

Giovannini, M., Seitz, F.X Ultrasound-guided percutaneous alcohol injection of small hver metastases. Results in 40 patients. Cancer 1994 73 294 - 297... 

Sana M, Llovet JM, Vilana R, Bianchi L, Sold M, Ayuso C, Brvi C, Bruix J (2004) Initial response to percutaneous ablation predicts survival in patients with hepatocellular carcinoma. Hepatology 40 1352-1360 Shankar S, van Sonnenberg E, Morrison PR, Tuncali K, Silverman SG (2004) Combined radiofrequency and alcohol injection for percutaneous hepatic tumor ablation. Am J Roentgenol 183 1425-1429... 

Amin Z, Bown SG, Lees WR (1993b) Local treatment of colorectal liver metastases a comparison of interstitial laser photocoagulation (ILP) and percutaneous alcohol injection (PAI). Clin Radiol 48 166-171... 

Rossi S, Fornari F, Pathies C et al (1990) Thermal lesions induced by 480 kHz localized current field in guinea pig and pig liver. Tumori 76 54-57 Scheele J, Stang R, Altendorf-Hofmann A et al (1995) Resection of colorectal liver metastases. World J Surg 19 59-71 Siperstein AE, Berber E (2001) Cryoablation, percutaneous alcohol injection, and radiofrequency ablation for treatment of neuroendocrine liver metastases. World J Surg 25 693-696... 

Microwave-induced coagulation can produce the ablation of a relatively large volume within a few minutes in liver the results are at least as good as those achieved with percutaneous alcohol injection (PEI) (Seki et al. 1999). It may become attractive for percutaneous use in lung tumors if clinically relevant lesions can be produced with a probe size of less than 2 mm. 

Liver resection can therefore be offered only to a small number of patients with a good chance of success. There is a demand for additional treatments to improve the success of resection and to diminish the incidence of recurrence after surgery, particularly in patients for whom surgery is not an option. Alternative methods include oncologic strategies, such as systemic or locoregional chemotherapy, and interventional techniques, including percutaneous alcohol injection, transarterial chemoembolization, microwave ablation, and percutaneous laser treatment (Lin et al. 1997). 

Percutaneous ethanoi injection (PEI) This procedure was described by N. Sugiura et al. in 1983. In solitary HCC with a size of <3 (-5) cm in diameter, alcohol (96 vol.%) is injected into the tumour using sonographic, laparoscopic (79) or CT monitoring. This technique (5-10 ml, about 3 times a week, regularly over a period of 3-4 months) is a relatively inexpensive procedure which is technically simple and well tolerated (albeit usually very painful ). Due to the fact that HCC has a soft consistency compared to the firmer liver tissue, it is possible to a large extent to infiltrate the tumour selectively and limit necrosis as desired, (s. fig. 37.9)... 

PEI Percutaneous injection therapy with alcohol or acetic acid is not recommendable in liver metastases. (325)... 

In combination therapy of unresectable hepatocellular carcinoma with transcatheter embolization and percutaneous injection of alcohol in 24 patients, 18 developed transient local pain and a burning sensation after the injection of alcohol, 16 had mild fever, and two had transient hypotension (4). 

Percutaneous injection of methylmethacrylate (cementoplasty see Chap. 10) or ethanol (alcoholization) may provide marked pain relief or bone strengthening in patients with malignant acetabular osteolyses who are unable to tolerate surgery. Injection of methylmethacrylate is usually indicated when osteolysis involves the weight-bearing bone (i.e., vertebral body, acetabular roof). In non-weight-bearing bones, ethanol injection is preferred. 

Fig. 2.9.1. a Hepatocellular carcinoma (3.8 cm in diameter) in liver segment 8 with only slight contrast enhancement in the arterial phase, b Needle placement under CT guidance into the dorsal part of the tumor, c CT directly after ethanol injection into the dorsal part of the tumor. The ethanol pools at the injection site, d CT after completion of percutaneous alcohol instillation (PAI) (60 ml of alcohol) with the tumor completely saturated with ethanol and the needle still in place in order to allow the alcohol to diffuse, e, f CT in the arterial (e) and the portovenous phase (f) directly after completion of PAL No tumor enhancement can be seen in the arterial phase. The portovenous phase demarcates the homogenous saturation of the tumor with ethanol... 

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