Tumori, 72: 525-527, 1986 PERCUTANEOUS INTERSTITIAL CHEMOTHERAPY OF A SMALL HEPATOCELLULAR CARCINOMA UNDER ULTRASOUND GUIDANCE Tito Livraghi, 1 Carlo Ravetto,2 Luigi Solbiati" and Fredy Suter• ('- Reparto di Radiologia II, Ospedale Civile, Vimercate, and 2 Reparto di Citodiagnostica, 3 Radiologia II, 4 Malattie lnfettive, Ospedale di Circolo, Busto Arsizio) A small ( < 3 cm) inoperable hepatocellular carcinoma was treated with percutaneous inter- stitial chemotherapy (PIC). 5-Fluorouracil was injected by a fine needle under ultrasound guidance. After 3 months a fine needle biopsy (FNB) yielded fibronecrotic material. After 18 months another FNB yielded steatosis and dysplastic cells and the lesion showed no increase in size. PIC could be an interesting alternative treatment for small tumors unresponsive to conventional therapies. A feasibility study of percutaneous interstitial chemotherapy (PIC) for deep-seated tumors, in particular of the pancreas, liver and lung, de- monstrated the safety of the method (2). The drugs were injected directly into the interstices of the tumor with a fine (22 g) needle under ul- trasound guidance. There were no noteworthy side effects, either local or systemic. Since a re- sponse, in terms of pain control and of volume reduction, was observed particularly in small tu- mors, it was decided to continue the study in selected cases. A multicentric treatment protocol was drawn up based on tumor size ( < 4 cm). We present here the first of these cases, a small he- patocellular carcinoma (SHCC), with an 18-month follow-up. Case report A 61-year-old man consulted us in September 1984 regarding dyspeptic disturbances and weak- ness, with jaundice and ascites. The patient had suffered for years from alcoholic cirrhosis and in 1968 underwent splenectomy with a Warren splenoportal shunting procedure after relapsing digestive tract bleeding. Since then he had enjoyed long periods of fairly good health, broken by sporadic bouts of jaundice with ascites. At the time of examination the pathologic laboratory data were: total bilirubin, 8.8 mg/di; free bilirubin, 3.5 mg/di; AST, 107 mU/ml; ALT, 308 mU/ml; gamma-GT, 440 mU/ml; alkaline phosphatase, 410 mU/ml; IgG, 2147 mg/di; IgA, 534 mg/di; IgM, 248 mg/di; serum AFP was normal. Abdominal ultrasonography showed, in addition to the ascites, enlargement of the liver with irregular contours and a diffusely coarse structure; between the third and fourth segments of the left lobe was a homogeneous slightly hypo- echoic nodule with regular contours and a dia- meter of 25 x 23 mm in longitudinal section (fig. la). About 3 weeks later, after the ascites and jaundice had cleared, percutaneous biopsy under ultrasound guidance demonstrated a well- differentiated HCC. Surgery was excluded because of the conco- mitant cirrhosis, so the patient was treated with PIC. He received 8 weekly doses of 5-fluorouracil Address for reprint requests: Dr. Tito Livraghi, Reparto di Radiologia II, Ospedale Civile, 20059 Vimercate (Milano), Italia. Received May 20, 1986. 525