A 60-year-old man diagnosed with unresectable hepatocellular carcinoma (HCC) presented to the hospital with pain in the perineal region. He had been taking lenvatinib every day for 2 months after he was diagnosed with HCC with metastases to the lymph node, small bowel mesentery, and retroperitoneal space. Enhanced abdominal computed tomography revealed mild elevation in intensity in the perineal subcutaneous tissue with subcutaneous emphysema. The patient was diagnosed with Common Terminology Criteria for Adverse Events grade 3, skin ulceration of stage IV with full-thickness skin loss and tissue necrosis in the muscular layer. The patient was taken off the medication with prescription of antibiotics, and after 3 weeks, the skin has fully recovered. This is the first report of an HCC patient who presented with a skin ulceration of stage IV after lenvatinib treatment. We recommend stopping the medication immediately and changing to alternative treatments with appropriate supportive care.
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Multiple lenvatinibāassociated skin ulcers: A case report and literature review Soo Hyun Jeon, Woo Jin Lee, Chong Hyun Won, Sung Eun Chang, Mi Woo Lee, Joon Min Jung Australasian Journal of Dermatology.2023;[Epub] CrossRef
Background/Aim s: Hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT)
exhibits poor prognosis. The aim of this study is to evaluate factors associated with survival of
HCC patients with PVTT to suggest better therapeutic options.
Methods Patients with HCC which were newly diagnosed at three tertiary hospitals between
January 2004 and December 2012, were reviewed retrospectively. Among them, Barcelona
Clinic of Liver Cancer stage C patients with PVTT were identified. Factors affecting overall
survival (OS) were analyzed and efficacies of the treatment modalities were compared.
Results Four hundred sixty five patients with HCC and PVTT were included. Liver function,
tumor burden, presence of extrahepatic tumor, alfa fetoprotein, and treatment modalities
were significant factors associated with OS. Treatment outcomes were different according
to the initial modalities. OS of the patients who received hepatic resection, radiofrequency
ablation (RFA), transarterial chemoembolization (TACE), hepatic arterial infusion chemotherapy
(HAIC), sorafenib, systemic cytotoxic chemotherapy, radiation therapy (without combination),
and supportive care were 27.8, 7.1, 6.7, 5.3, 2.5, 3.0, 1.8, and 0.9 months, respectively (P<0.001).
Curative-intent treatments such as hepatic resection or RFA were superior to noncurativeintent
treatments (P<0.001). TACE or HAIC was superior to sorafenib or systemic chemotherapy
(P<0.001). Combining radiotherapy to TACE or HAIC did not provide additional benefit on OS
(P=0.096).
Conclusions Treatment modalities as well as baseline factors significantly influenced on
OS of HCC patients with PVTT. Whenever possible, curative intent treatments should be
preferentially considered. If unable, locoregional therapy would be a better choice than
systemic therapy in HCC patients with PVTT.
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Value of surgical resection compared to transarterial chemoembolization in the treatment of hepatocellular carcinoma with portal vein tumor thrombus: A meta-analysis of hazard ratios from five observational studies Keera Kang, Sung Kyu Song, Chul-Woon Chung, Yongkeun Park Annals of Hepato-Biliary-Pancreatic Surgery.2020; 24(3): 243. CrossRef
In patients with advanced hepatocellular carcinoma (HCC), tumor thrombus in inferior vena cava (IVC) and right atrium (RA)
are not uncommon findings and are usually associated with extremely poor outcome. Although aggressive surgical interventions
such as extracorporeal circulation and tumor excision have been performed, the reported results were still unsatisfactory. Herein,
we report the favorable result of combined treatment with radiation therapy and transarterial chemoembolization in a patient with
advanced HCC with extensive tumor thrombus through the IVC into the RA. In conclusion, noninvasive combined modalities,
such as transarterial chemoembolization and radiation therapy may sometimes provide effective palliation for patients with far
advanced HCC with IVC/RA tumor thrombus and who are not candidates for alternative treatment options.
Sun Jae Lee, Hyung Joon Yim, Hwan Hoon Chung, Hae Rim Kim, Eileen L. Yoon, Jong Jin Hyun, Sung Woo Jung, Ja Seol Koo, Rok Son Choung, Sang Woo Lee, Jai Hyun Choi
Journal of the Korean Liver Cancer Study Group. 2012;12(1):67-70. Published online February 28, 2012
35-year-old female patient was diagnosed with hepatocellular carcinoma and underwent hepatic resection. 12 months after
hepatic resection, serum AFP rose (119.6 ng/mL) but no definite recurrence was found on imaging modalities. 30 months after
hepatic resection, serum AFP rose up to 1008.5 ng/mL and metastatic nodule was found in right lower lung in chest CT. Video
assisted thoracoscopic wedge resection was performed and 400 mg/day of sorafenib was intiated. Serum AFP returned to normal
range after 2 months of pulmonary resection. No evidence of recurrence is noted after 30 months of pulmonary resection. We
think that pulmonary resection plus sorafenib combination therapy resulted in favorable treatment outcome in this patient.
Conventional transarterical chemoembolization (TACE) is the first-line treatment for patients with intermediate stage of
hepatocellular carcinoma (HCC). However, irreversible liver failure after the procedure is one of the most feared complications
and therefore, decompensated Child-Pugh C patients may not be the indication of the conventional TACE. Drug-eluting beads
loaded with doxorubicin is a novel drug delivery embolization system and reported to have non inferior efficacy compared to
conventional TACE. Also drug-eluting beads loaded with doxorubicin is associated with lower rates of acute liver failure after
the procedure and lower rates of systemic toxicity of the chemotherapeutic agents. Herein, we report a case of aggressive
treatment with transarterial embolization using drug-eluting beads loaded with doxorubicin for HCC in decompensated liver
cirrhosis patient who was not eligible for conventional TACE treatment.