Ultrasound guided percutaneous ethanol injection (PEI) in the control of liver metastases from colorectal carcinoma

Abstract Objective: To evaluate the efficacy and tolerability of percutaneous ethanol injection (PEI) in patients with metastases of colorectal origin, on the basis of the optimum results obtained by PEI in the treatment of hepatocellular carcinoma. Methods: Between April '91 and May '94, 33 lesions, mean diameter of 2.9 cm in 22 pts were treated. After correct positioning of the needle under ultrasound control inside the metastases, sterile alcohol at 95 ° was administered. Response was measured by means of a fine needle echo-guided biopsy (FNAB) carried out at the end of treatment: Complete Response (CR) = necrosis and absence of malignant tumor cells (MTCs); Partial Response (PR) = necrosis and rare, atypical and ailing MTCs. Results: Of the 27 evaluable lesions, 23 (17 pts) responded to PEI (85.1%): CR in 7 27 (25.9%), PR in 16 27 (50.2%). Histological confirmation was obtained in 9 10 lesions surgically resected. Three lesions remained unchanged (NC) and one lesion progressed (PRO). CEA modification was observed in 12 23 responsive lesions (normalization in seven, significant reduction in five). PEI was well tolerated and no complications were observed for the total of 706 performed alcoholizations. Eight of twenty two pts died after a mean survival of 12.8 months [1–31]. Overall survival was 12.8 months. Conclusions: The results seem to suggest that PEI may be a useful alternative in controlling liver metastases; it deserves further study in large populations and over a longer period of time.