Administration of 98% ethanol destroys tissues by coagulative necrosis. In the rat bearing 1,2-dimethylhydrazine-induced colonic carcinoma which has spread to the liver, direct injection of 0.1–0.2 ml ethanol into each of the hepatic metastases at the time of total colectomy afforded a significant survival advantage relative to colectomy alone (20.1 ± 0.2 vs 12.8 ± 0.2 months of age, mean ± SEM, n = 20, p < 0.01 by the Mann-Whitney U test). A pilot study was, therefore, carried out (2 women and 4 men, age range 43 to 71 years—mean 56) to examine the clinical significance of these observations in patients with multiple hepatic metastases from carcinoma of the sigmoid colon. The tumour was resected then all palpable hepatic secondaries were injected with 1–1.5 ml of 98% ethanol. Two weeks post-operatively and thereafter once every two months any hepatic lesions detected ultrasonically were similarly treated percutaneously. All the patients tolerated this treatment without any observed distress or adverse effects. Their mean survival measured from the time of tumour resection until death from any cause was 20 months (range 17 to 26 months). The survival gain afforded by chemonecrosis in addition to its simplicity and safety deserves further consideration to assess the exact role of this method in the treatment of liver metastases from colonic cancer.
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