Safety and Efficacy of Percutaneous Ethanol Injection of Caudate Hepatocellular Carcinoma

Purpose: Hepatocellular carcinoma (HCC) in the caudate lobe is technically challenging to treat with transarterial chemoembolization (TACE) given its variant arterial supply. This study aims to report safety and efficacy of percutaneous ethanol injection (PEI) for caudate HCC.

Materials and Methods: A Institutional Review Board-approved retrospective evaluation of all patients with HCC who have had caudate lobe PEI at a single tertiary care center from 2009 to 2015 was performed. Electronic medical record and pre-, intra- and post-procedural imaging were retrospectively assessed in each patient for clinical outcome and imaging response by mRECIST criteria.

Results: Twelve patients with mean age of 64 years who underwent PEI of 13 caudate lobe HCC lesions were identified. Causes of HCC included hepatitis B virus (n = 3), hepatitis C virus (n = 3), alcoholic cirrhosis (n = 4), and cryptogenic cirrhosis (n = 1). The average caudate mass measured 2.6 cm (range, 1.3–4.4 cm). Six lesions were in the Spiegel lobe, four lesions in the caudate process, and two lesions in the paracaval region. Six patients (50%) had lesions limited to the caudate. In the immediate post-procedural period, one patient had ascites requiring paracentesis. There were no other documented post-procedural complications. On subsequent imaging, based on the mRECIST criteria, two lesions (18%) demonstrated complete response, one lesion (9%) showed partial response, five lesions (45%) had stable disease, while two lesions (18%) progressed. Seven patients (58%) survived to transplant with mean days-to-transplant of 86 (range, 36–824).

Conclusion: Caudate HCC, which is technically challenging to treat given its arterial anatomy and location, can be safely treated with PEI. Disease control can be achieved in the majority of cases. As such, PEI may be useful as bridging therapy prior to liver transplant.

No conflict of interest has been declared by the author(s).