# Enhanced ethanol ablation as a surgical-alternative for head and neck cancer treatment in resource-limited settings

> **NIH NIH F31** · DUKE UNIVERSITY · 2020 · $14,036

## Abstract

Abstract: Head and neck cancer (HNC) affects the lives of nearly half a million people in low-and-middle-
income countries (LMICs) annually resulting in over 250,000 deaths. While surgery and radiotherapy are the
mainstays of effective treatment in high-income countries (HICs), access to these treatment modalities in
LMICs is limited to under 10% of the population. The low cost and portability of ablative techniques makes
them well-poised to provide the efficacy of surgery and radiotherapy that are commonplace in HICs to the
resource-limited settings of LMICs. While current ablative techniques are either expensive, electricity-
dependent, or not portable, our group has developed a novel technique that is suited for the demands of
LMICs. This technique (termed “enhanced ethanol ablation”) is a modification of ethanol ablation, which has
been used extensively in the treatment of unresectable hepatocellular carcinomas. Enhanced ethanol ablation
involves the direct injection of ethyl cellulose-ethanol into malignant tissue. Ethyl cellulose (generally regarded
as safe by the FDA) is ethanol-soluble and forms a viscous solution which can be injected through a standard
needle but is water-insoluble and forms an ethanol-rich gel upon contact with the aqueous environment of
biological tissue. In a proof-of-concept study with oral squamous cell carcinoma tumors in the hamster cheek
pouch, 7 of 7 tumors completely regressed when treated with enhanced ethanol ablation.
 Due to the superficial nature of HNCs, shallow needle insertion depths must be used to spare underlying
healthy tissue. Shallow insertion depths increase the risk of backflow (flow out of the tumor along the needle
pathway). To minimize backflow, the needle insertion rate must be optimized to limit tissue damage during
needle insertion to maximize the force exerted on the needle by the tissue. Since HNCs have a heterogenous
mechanical environment, they are vulnerable to crack formation (flow out of the tumor into surrounding tissue
caused by fluid-induced tissue damage) at sites of low fracture toughness (such as necrotic areas). Optimizing
the fluid infusion rate can minimize fluid-induced tissue damage, ensuring lower rates of crack formation and
increased injected fluid accumulation within the tumor. Upon optimizing the injection protocol, the injection
volume must be tuned to induce necrosis throughout the entire tumor while sparing surrounding tissue.
 The central hypothesis of this proposal is that upon optimization of both the injection protocol and the
dosage, enhanced ethanol ablation will be comparable to the standard-of-care (surgery) and the most common
ablative therapy in LMICs (cryotherapy). This hypothesis will be addressed in three specific aims, all of which
will utilize an immunocompetent rat model of oral SCCs. First, the injection protocol will be optimized to
maximize injected fluid distribution within the tumor. Next, the injection volume will be tuned to ablate a
clinic...

## Key facts

- **NIH application ID:** 9969039
- **Project number:** 5F31CA239623-02
- **Recipient organization:** DUKE UNIVERSITY
- **Principal Investigator:** Robert Morhard
- **Activity code:** F31 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $14,036
- **Award type:** 5
- **Project period:** 2019-07-01 → 2020-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9969039

## Citation

> US National Institutes of Health, RePORTER application 9969039, Enhanced ethanol ablation as a surgical-alternative for head and neck cancer treatment in resource-limited settings (5F31CA239623-02). Retrieved via AI Analytics 2026-07-16 from https://api.ai-analytics.org/grant/nih/9969039. Licensed CC0.

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