Ultrasound-guided percutaneous boiling carboplatin injection (PBCI) for the treatment of small hepatocellular carcinoma: a preliminary study.

BACKGROUND/AIMS: To evaluate the therapeutic efficacy of ultrasound-guided percutaneous injection of boiling carboplatin (PBCI) for small hepatocellular carcinoma (HCC).

METHODOLOGY: PBCI was used to treat 34 HCC patients with 57 tumor nodules less than 3cm in diameter. Thirty-two of them (94.1%) were recurrent cases, including postoperative recurrence in 28, recurrence after percutaneous microwave coagulation therapy in 2 and recurrence after transcatheter arterial chemoembolization in 2. The remaining 2 had an initially treated HCC. Two sessions of PBCI were administered within 1 week for each tumor nodule. Its influences on liver function and blood cell count were monitored. Local recurrence rate, incidence of distant recurrence and survival rate were calculated by Kaplan-Meier method and their influencing factors were analyzed.

RESULTS

Patients had a mean follow-up time of 12.7 +/- 5.4 months (from 3 to 22 months). Amount of boiling carboplatin solution (5mg/mL) injected per session ranged from 3mL to 35mL (10.9 +/- 6.9mL), and the total amount used in the two-session course ranged from 6mL to 65mL (21.8 +/- 13.4mL). Of 57 tumor nodules treated with two-session PBCI, technical success was achieved in 53 (93.0%). The cumulative local recurrence rate at 3, 6, 12, 18 months was 3.5%, 7.3%, 16.2% and 16.2%, respectively, with a mean local recurrence-free time of 19.4 +/- 0.8 months. Eighteen out of 34 patients (52.9%) developed distant recurrence, with a mean interval time to distant recurrence of 11.6 +/- 1.4 months. Incidence of distant recurrence at 6, 12, 18 months was 34.1%, 53.2% and 64.5%, respectively. The 1-year and 1.5-year survival rates were 78.3% and 64.2%, respectively, with a mean survival time of 17.8 +/- 1.1 months. Of 28 postoperative recurrent patients, PBCI markedly prolonged the mean postoperative tumor-free survival time from 21.1 +/- 3.4 months to 36.2 +/- 4.7 months (p<0.01). Univariate analysis demonstrated that patients with Child-Pugh grade A liver function had a significantly longer survival time and greater survival rate than those with grade B and C (p<0.05). There were no remarkable changes in liver function and complete blood cell count after PBCI and no major complications were observed.

CONCLUSIONS

PBCI represented as an effective and safe percutaneous injection therapy for small HCC. It needed only two sessions for the vast majority of HCC less than 3cm in diameter and thus had the advantage of being much less invasive.