Ultrasound-guided percutaneous alcohol injection of small liver metastases. Results in 40 patients.

Background: Ultrasound-guided percutaneous alcohol injection (PAI) is used in the treatment of hepatocellular carcinoma. The aim of this study is to evaluate the results of treatment with PAI of liver metastases (LM) that measure fewer than 5 cm in diameter, where three or less lesions are present.
Methods: Between December 1987 and November 1992, 40 patients were treated for one or more liver tumors (n < or = 3). These 40 patients had a total of 55 lesions. There were 55 LM: 32 cases of colorectal origin, 9 cases of mammary origin, 5 cases with a carcinoid tumor, 4 with an undifferentiated tumor, 3 with cancer of the uterus, 1 with an epidermoid cancer of the esophagus, and 1 with a bronchogenic carcinoma. The tumor has been considered spherical and the total volume of alcohol used depends on the diameter of the tumor. The volume was calculated using the formula V = 4/3 pi [r + 0.5]3; this volume was injected during several sessions, not more than 10 ml per injection. The injections were performed once a week until the calculated volume was reached.
Results: Of the 55 tumors treated, there was a complete necrosis in 31 cases (56.3%). The median survival of the 40 patients was 21 months, with a 3-year actuarial survival of 39%. Among patients with LM of colorectal origin, the median survival was increased when the total necrosis was obtained (38 months versus 21 months, P < 0.04).
Conclusion: PAI seems to be a therapeutic alterative when surgery is contraindicated or when LM are resistant to chemotherapy.