Ethanol injection is the most widely used interstitial technique to treat primary liver tumours. The use of PEI to treat secondary liver tumours has shown poor effectiveness.
The intralesional injection of alcohol causes cell dehydration and tissue ischaemia due to thrombosis of the neoplastic vessels caused by the necrosis of the endothelial cells and by platelet aggregation. The poor effectiveness of PEI in the treatment of metastasis is probably due to the higher presence of the fibrous tissue, limiting the diffusion of alcohol.
PEI is used in small lesions (<5 cm) and complete response can be achieved in about 50% of lesions of colorectal metastases after multiple treatments. For this reason, use of this treatment for colorectal metastasis is very limited and controversial; more recently PEI was replaced by thermo-ablation.
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