Transarterial chemoembolization combined with percutaneous ethanol injection for the treatment of hepatocellular carcinoma at high-risk areas.

Purpose: To analyze the efficacy and safety of the combination of transarterial chemoembolization (TACE) with percutaneous ethanol injection (PEI) in the treatment of hepatocellular carcinoma (HCC) at high-risk areas.

Materials and methods: Data from cases involving TACE combined with PEI for HCC treatment in high-risk regions were analyzed from January 2016 to December 2023 at three medical centers. High-risk areas were defined as those less than 10 mm from the diaphragm, gallbladder, gastrointestinal tract, or secondary branches of the portal vein or bile duct. The guidance modalities for PEI were computed tomograph (CT) and cone beam computed tomograph (CBCT). Each lesion received only one session of TACE combined with PEI. Treatment efficacy was assessed by complete ablation rate of target lesions at the 2-month follow-up. Factors affecting the efficacy were determined by binary logistic regression analysis. The difference in efficacy between CT-guided and CBCT-guided PEI was analyzed by Chi-square test.

Results: About 62 patients with 67 target lesions were included in the analysis. The overall complete ablation rate lesion-based was 80.6% (54/67). Lesion diameter was significantly associated with the probability of achieving complete ablation (OR = 6.89, 95% CI: 1.57-30.234, P = 0.011). There was no significant difference in the complete ablation rates between CT- and CBCT-guided approaches (83.3% vs. 80%, P = 0.867). No severe complications occurred during treatment or follow-up.

Conclusion: The combination of TACE with a single PEI proves to be a safe and effective treatment for HCC in high-risk areas. There was no difference between CBCT-guided and CT-guided outcomes.