Hepatocellular carcinoma treated by percutaneous hot saline injection

Percutaneous ethanol injection therapy (PEI) is one of the local methods widely used for hepatocellular carcinoma (HCC) ablation. However, this method is limited by the toxicity of ethanol and severe pain derived from irritation of the peritoneum of the liver capsule. Therefore, we have focused on the heat coagulation necrosis effect of boiled hot saline and devised percutaneous hot water injection therapy (PHoT) as a new local treatment method. PHoT was performed in 17 patients with HCC (total 24 nodules: 11 nodules <2 cm in diameter, 10 nodules from 2-4 cm, and 3 nodules >4 cm). Changes in the AFP values, and both CT and ultrasonography (US) findings before and after treatment were investigated. All 24 tumors received 1 or more treatments (average, 3.3 treat-ments) of PHoT. The injection volume ranged from 3-26 ml (average, 11.2 ml). The total volume of the injection per tumor ranged from 10-37.2 ml (average, 37.2 ml). The AFP values decreased in all patients who initially showed high values. On CT scanning, all lesions receiving PHoT became hypodense. The disappearance of the tumor was also confirmed by contrast-enhanced CT. No severe complications, excluding mild abdominal pain and skin burning, were observed during the procedure. In conclusion, PHoT shows good anti-tumor effects despite a small number of punctures and holds promise as a curative local treatment method for small HCCs.