| PURPOSE:To investigate the safty of transarterial ethanol ablation with ethanol-lipiodol mixture(TEA) and the appropriate ratio of ethanol in the mixture used in the TEA via observing the pathological changes of the embolizied liver lobe after the transcatheter hepatic arterial embolization with different ratio of the ethanol-lipiodol mixtures in rabbits in our experimental study.To compare treatment effectiveness of transarterial ethanol ablation(TEA) versus those of chemoembolization in the clinical study to improve the prognosis of the patients suffer from hepatic carcinoma.MATERIALS AND METHODS:1.Experimrntal study:A total of 40 New Zealand White rabbits weighing 2.5-3.0 kg were used in this experiment.They were randomly divided into four groups of ten rabbits each.In each of three groups,a mixture of ethanol and lipiodol(37%iodine) in a ratio of 1:2,1:1,2:1,or 0:1was used which was injected into artery of hepatic segment of the right liver lobe through the catheter.All the vital signs were monitored intra-operatively and blood spicemens were collected on day 1 and the 3rd,7th day after the experiment to test the hepatic funtion.2 weeks after the experiment,all the rabbits were killed after the hepatic DSA to observe the pathological changes.2.Clinical trial:A case-controlled study was undertaken with 20 patients in each group matched based on Child-Pugh grade,tumor characteristics,and performance status.The experimental group were treated with transarterial ethanol ablation with the ethanol-lipiodol mixture in a ratio of 1:1,and the control group were received chemoembolization.Detected the level of the alphafetoprotein(AFP) of all case before and after the therapy.The side effects of the therapy were recorded after the operation.The endpoints were treatment effectiveness as evaluated by tumor necrosis,tumor response,disease progression,progression-free survival and overall survival.RESULTS:1.Experimental Study:Transcatheter arterial liver lobe embolization was successfully performed in the 40 rabbits.All animals tolerated the procedures well and lived until the time of their designated killing.The levels of AST and ALT of the four groups increased on the 1st day after arterial embolization and recoveried a week later.Recanalization occurred in the embolized artery of the control group 2 weeks after the operation detected by the heptic DSA,but none of the embolized artery Recanalizated in the the other 3 groups.Pathological section of the liver lobe ablated with the lipiodol-ethanol mixture (1:2,1:1,2:1)show that necrotic grossly 2 weeks after the experiment,tunica intima destruction and coagulation necrosis of the tissue feeded by embolized vessel were achieved in the group B(1:1) and group C(2:1),necrotic effect of the group C(2:1) is the better than the group B(1:1) which were best in the 3 group experimented with TEA.We also found that the mixture of ethanol and lipiodol in a ratio of 2:1 was not asy to detect in the DSA for the low proportion of the lipiodol.2.Clinical Study:The level of alphafetoprotein(AFP) before and after the therapy existed significant different(P＜0.05).The level of AFP droped after the therapy between the two group had a significant difference(P＜0.05).In the TEA group,4 patients had achieved the complete tumor necrosis,14 patients had tumor necrosis＞60%,compared with none complete tumor necrosis and 9 patients had tumor necrosis＞60%among their matched controls(P=0.001);No difference on the side effects of fever,stomachache and vomit caused by arterial embolization between the two groups(P＞0.05);The incidence rate of bone marrow depression was higher in the control group(P＜0.05);The median survival in the TEA group is 26 months,and 21 months in the TACE group,The accumulative survival rate of 6 months,1 year and two years were 100%,90%,60%in the TEA group VS 90%,70%and 35%in the TACE group.There was a significant different of the total survival in the two group with the Long-rank test.CONCLUSIONS:TEA with the ethanol and lipiodol mixture in the ratio of 1:1 can achieve the arterial ambolization and the ablated tissue complete necrosis and also easy to detect in the DSA,no serious complication occurred in the study,so the mixture in the ratio of 1:1 is is the best choice of the 3 used in arterial embolization of liver carcinoma;The TEA achieved higher tumor necrosis, prolonged survival time of patients suffer from hepatocellular carcinoma,and less side effects compare to TACE.So it is superior to those of chemoembolization for HCC.
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