Review Article

Evolving Ablative Therapies for Hepatic Malignancy

Table 2

Summary of studies with chemical ablation (PEI and PAI) in patients with primary and metastatic liver malignancy.

Author(s)YearType of studySummary and outcome(s)

Shiina et al. [22]2012Case seriesAim: to evaluate long-term outcomes in patients treated with PEI for HCC
Study data: 685 patients treated with 2147 treatments
Conclusions: 5-, 10-, and 20-year survival rates were 49.0%, 17.9%, and 7.2%, respectively; PEI was potentially curative for HCC, resulting in OS of >20 years

Schoppmeyer et al. [26]2009Cochrane reviewAim: to evaluate the effects of PEI or PAI in adults with early HCC
Study data: three RCTs, 261 patients
Conclusions: PEI and PAI do not differ significantly

Riemsma et al. [27]2013Cochrane reviewAim: to compare effects of PEI with other treatments in patients with liver metastasis
Study data: one RCT, 48 patients
Conclusions: addition of PEI to TACE does not confer clear benefit in survival

Cho et al. [28]2009Systematic reviewAim: to compare effects of PEI with other treatments in patients with liver metastasis
Study data: four RCTs, 652 patients
Conclusions: RFA provides improved 3-year survival in patients with HCC, when compared to PEI

Orlando et al. [29]2009Meta-analysisAim: to compare effects of PEI with RFA in patients with small HCC
Study data: five RCTs, 701 patients
Conclusions: RFA is superior to PEI with respect to OS, DFS and 1-, 2-, and 3-year survival rates; RFA has better tumor response and smaller risk of local recurrence

Chen et al. [30]2006RCTAim: to compare PEI with surgical resection in patients with small HCC
Study data: 180 patients were randomized into two groups
Conclusions: chemical ablation is less invasive and as effective as surgical resection

Koda et al. [31]2001RCTAim: to compare PEI + TACE with PEI alone in patients with small HCC
Study data: 52 patients were randomized into two groups
Conclusions: combined PEI + TACE is superior to PEI alone in the treatment of patients with HCC tumors measuring <2 cm in greatest dimension

Giovannini [32]2002ReviewAim: to evaluate effects of PEI in patients with liver metastasis
Study data: review of multiple studies
Conclusions: PEI is effective in only a selected group of patients with small metastases from colorectal, mammary, and endocrine tumors when surgery is contraindicated

DFS: disease-free survival; HCC: hepatocellular carcinoma; OS: overall survival; PEI: percutaneous ethanol injection; PAI: percutaneous acetic acid injection; RFA: radiofrequency ablation; RCT: randomized controlled trial; TACE: Transarterial chemoembolization.