Percutaneous hot saline injection therapy: Effectiveness in large hepatocellular carcinoma

PURPOSE: To report on the efficacy of percutaneous hot saline injection therapy (PSIT) in the treatment of large hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Twenty-nine patients with 31 HCCs underwent PSIT. Physiologic saline was mixed with contrast medium and Lipiodol; this mixture was boiled and injected into the tumor. Mean tumor diameter was 7.0 cm. Initial regression rates were evaluated at 3-month interval with computed tomography (CT) and α-fetoprotein level measurement. Cumulative survival rates were calculated with the Kaplan-Meier method. Multivariate analysis using Cox's proportional hazard regression model was performed to determine the significant prognostic factors. RESULTS: Initial regression rate for all tumors at a 3-month interval was 42% (13 of 31 tumors) and the median survival was 10.0 months (range, 3.0-36.0 months). The significant prognostic factors were encapsulated tumors, tumors less than 10 cm in diameter, tumors with even saline dispersion, tumors with initial regression at 3-month follow-up, and TNM stage II or III rather than IV. CONCLUSION: PSIT is a feasible alternative treatment for a large HCC when transcatheter arterial chemoembolization is not feasible or has failed.