Chapter 088. Hepatocellular Carcinoma (Part 7) Local Injection Therapy Numerous agents have been used for local injection into tumors, most commonly, ethanol (PEI). The relatively soft HCC within the hard background of cirrhotic liver allows for injection of large volumes of ethanol into the tumor without diffusion into the hepatic parenchyma or leakage out of the liver. PEI causes direct destruction of cancer cells, but it is not selective for cancer cells and will destroy normal cells in the vicinity. It usually requires multiple injections (average of three), in contrast to one for RFA. The maximum size of tumor reliably treated. | Chapter 088. Hepatocellular Carcinoma Part 7 Local Injection Therapy Numerous agents have been used for local injection into tumors most commonly ethanol PEI . The relatively soft HCC within the hard background of cirrhotic liver allows for injection of large volumes of ethanol into the tumor without diffusion into the hepatic parenchyma or leakage out of the liver. PEI causes direct destruction of cancer cells but it is not selective for cancer cells and will destroy normal cells in the vicinity. It usually requires multiple injections average of three in contrast to one for RFA. The maximum size of tumor reliably treated is 3 cm even with multiple injections. Liver Transplantation A viable option for stages I and II tumors in the setting of cirrhosis is OLTX with survival approaching that for noncancer cases. OLTX for patients with a single lesion 5 cm or three or fewer nodules each 3 cm Milan criteria resulted in excellent tumor-free survival 70 at 5 years . For advanced HCC OLTX has been abandoned due to high tumor recurrence rates. Priority scoring for OLTX previously led to HCC patients waiting too long for their OLTX resulting in some tumors becoming too advanced during the patient s wait for a donated liver. A variety of therapies were used as a bridge to OLTX including RFA PEI and transarterial chemoembolization TACE . These pretransplant treatments allow patients to remain on the waiting list longer giving them greater opportunities to be transplanted. What remains unclear is whether this translates into prolonged survival after transplant. Further it is not known whether patients who have had their tumor s treated preoperatively follow the recurrence pattern predicted by their tumor status at the time of transplant . post local ablative therapy or if they follow the course set by their tumor parameters present before such treatment. The United Network for Organ Sharing UNOS point system for priority scoring of OLTX recipients now includes additional .
