Journal of Liver Cancer

Case Reports

A Case of Early Recurred Hepatocellular Carcinoma with Initial Expectation of Good outcome by Surgical Resection: Jung Min Lee, Jun Yong Park, Do Young Kim, Kyung Sik Kim, Young Nyun Park, Myeong-Jin Kim, Chae Yoon Chon, Kwang-Hyub Han; Journal of the Korean Liver Cancer Study Group. 2009;9(1):41-44. Published online June 30, 2009

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Abstract PDF: Hepatocellular carcinoma (HCC) is one of the cancers with poor prognosis as HCC develops on base of cirrhosis in majority cases, which requires multidisciplinary approach. If feasible, however, surgical resection is the choice of treatment, and many previous studies and guidelines offered appropriate indications for surgical resection; firstly, preservation of liver function should be confirmed with traditional Child-Pugh classification or more recently with Indocyanine Green retention test or absence of portal hypertension. Secondly, several variables about the size, number, and vascular invasion of tumor should be taken into consideration. It is suggested that to lessen the risk of recurrence gross vascular invasion be absent and the number of tumor be single. Regarding the size of tumor, although risk of dissemination increases with size, some tumors may grow as a single mass and thus the size of tumor is not a clear-cut limiting factor. Based on above suggestions, we herein offer our experience of a patient with initial hopeful expectation of good outcome with surgical resection, but who eventually turned out to result in disseminated tumor recurrence. Further study, maybe regarding a combination of adjuvant or neoadjuvant transarterial chemoembolization/chemotherapy or radiotherapy, is necessary on how to manage such patient.

A Case of Curative Resection of Advanced Hepatocellular Carcinoma After Localized Concurrent Chemo-Radiation Therapy: Jee Suk Kwon, Jeong Eun Lee, Woo Young Park, Kyung In Lee, Eun Soo Kim, Byoung Kuk Jang, Woo Jin Chung, Kyung Sik Park, Kwang Bum Cho, Jaeseok Hwang; Journal of the Korean Liver Cancer Study Group. 2009;9(1):67-70. Published online June 30, 2009

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Abstract PDF: Advanced hepatocellular carcinoma (HCC) with portal vein thrombosis is not suitable candidates for surgical treatment at the most of diagnosis because of poor liver function, extensive tumor involvement of the liver, vascular involvement, and/or intra/extrahepatic metastasis. We attempted localized concurrent chemo-radiation therapy (CCRT) in patients having locally advanced HCC with left and main portal vein thrombosis. We report a case of locally advanced HCC patient who became surgically resectable by downstaging after localized CCRT. Localized CCRT was performed with a total radiation dose of 5,040 cGy (180 cGy×28 times) and hepatic arterial infusion of 5-fluorouracil (5-FU, 250 mg/day) and cisplatin (10 mg/day) for 5 days via implantable port system during the second and the fifth weeks of the radiotherapy. Marked contraction of HCC was noted on follow up computerized tomography (CT) after localized CCRT, and subsequently surgical resection with curative aim was performed. He was gave a additional transcatheter arterial chemoembolization (TACE) because follow up CT revealed intrahepatic metastasis at subcapsular portion of right hepatic lobe after 3 months of operation. The patient is in complete remission status without recurrence to date.

A Case of Advanced Hepatocellular Carcinoma in Twenties Treated by Multimodality Therapy: Jang Eun Lee, Na Ri Yoon, Si Hyun Bae, Jong Young Choi, Seung Kew Yoon, Dong Goo Kim, Ho Jong Chun, Byung Gil Choi, Hae Giu Lee, Hong Seok Jang, Chan Kwon Jung, Eun Sun Jang; Journal of the Korean Liver Cancer Study Group. 2009;9(1):82-85. Published online June 30, 2009

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Abstract PDF: The prognosis of young patients with hepatocellular carcinoma is remains controversial. Here we report a case of advanced hepatocellular carcinoma in twenty, successfully treated with transarterial chemolipidolization (TACL), systemic chemotherapy, radiation therapy and surgical resection. Previously healthy 28 years old woman was admitted for treatment of hepatocellular carcinoma. Abdominal CT showed a diffuse infiltrative HCC involving both lobes with intrahepatic bile duct invasion and pericardial lymphadenopathy. She was treated TAC with systemic chemotherapy and external beam radiotherapy. 6 months after these treatments, main tumor and the pericardial lymph node were decreased in size. And then extended left lobectomy and systemic chemotherapy were done. The pericardial lymph node was markedly decreased. The patient has been followed for 10 months without evidence of regional tumor recurrence.

A Case of Curative Resection of Advanced Hepatocellular Carcinoma After Localized Concurrent Chemo-Radiation Therapy: Wonseok Kang, Ki Tae Yoon, Jun Yong Park, Do Young Kim, Sang Hoon Ahn, Chae Yoon Chon, Kyung Sik Kim, Young Nyun Park, Jin Sil Seong, Kwang Hyub Han; Journal of the Korean Liver Cancer Study Group. 2008;8(1):98-101. Published online June 30, 2008

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Abstract PDF: Most patients with advanced hepatocellular carcinoma (HCC) are not suitable candidates for surgical treatment at the time of diagnosis because of poor liver function, extensive tumor involvement of the liver, vascular involvement, and/or intra/extrahepatic metastasis. We attempted localized concurrent chemo-radiation therapy (CCRT) followed by hepatic arterial infusion chemotherapy (HAIC) in patients having locally advanced HCC with vascular involvement and preserved hepatic function. We report a case of locally advanced HCC patient who became surgically resectable by downstaging after localized CCRT followed by HAIC. Localized CCRT was performed with a total radiation dose of 4,500 cGy (180 cGy × 25 times) and hepatic arterial infusion of 5-fluorouracil (5-FU, 500 mg/day) via implantable port system during the first and the last weeks of the radiotherapy. Following localized CCRT, the patient was scheduled to receive HAIC with 5-FU (500 mg/m2 for 5 hours, days 1～3) and cisplatin (60 mg/m2 for 2 hours, day 2) every 4 weeks. Marked contraction of HCC was noted on follow up computerized tomography (CT) and positron emission tomography (PET) after localized CCRT and HAIC, and subsequently surgical resection with curative aim was performed. The patient is in complete remission status without recurrence to date.

A Case of Advanced Hepatocellular Carcinoma with Inferior Vena Caval Invasion, Resected with a Curative Aim after Concurrent Chemo-Radiation Therapy: Seung Up Kim, Kwang Hyub Han, Jin Sil Sung, Do Young Kim, Sang Hoon Ahn, Gyeong Sig Kim, Young Nyun Park, Chae Yoon Chon; Journal of the Korean Liver Cancer Study Group. 2007;7(1):77-81. Published online June 30, 2007

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Abstract PDF: Hepatocellular carcinoma (HCC) with tumor thrombus in inferior vena cava (IVC) is difficult to treat. Therefore, there are no specific treatment modalities for such case. Here, we present a patient diagnosed as hepatocellular carcinoma with tumor thrombus in inferior vena cava (stage IVa). The patient was treated with concurrent chemo-radiation therapy (CCRT) for 5 weeks. After that, tumor size was markedly decreased, and 9th courses of additional intra-arterial chemotherapy were performed. Follow-up positron emission tomography- computed tomography (PET-CT) showed shrinked hepatocellular carcinoma and right lobe, disappearance of IVC tumor thrombus, decreased size of right hepatic vein thrombus and a faint uptake at gallbladder. Residual malignancy could not be excluded. So, right hepatic lobectomy with a curative aim was performed and its result was successful.

Curative Resection of Advanced Hepatocellular Carcinoma (TNM stage IVa) after Concurrent Chemo-Radiation Therapy: A Case Report: DY Kim, KH Han, SH Ahn, CM Moon, KK Kim, CY Chon, YM Moon, KS Kim, JS Sung, YN Park; Journal of the Korean Liver Cancer Study Group. 2005;5(1):22-26. Published online June 30, 2005

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Abstract PDF: Hepatocellular carcinoma (HCC) with portal vein thrombosis is a difficult form of HCC to treat. Therefore, no specific treatment mordality has been absent. Here, we present a patient diagnosed as hepatocellular carcinoma with right portal vein thrombosis (stage IVa). The patient had been treated with concurrent chemo-radiation therapy (CCRT) for five weeks. After CCRR, tumor size was markedly decreased. Two courses of additional transcatheter arterial chemoembolization (TACE) and five courses of intraarterial 5-fluorouracil (5-FU)/cisplatin infusion were performed. Follow-up computerized tomography (CT) scan showed about 2cm-sized nodular lesion at lateral margin of right hepatic lobe. On angiography, it was shown that both the mass and intestine were commonly supplied by omental artery. For the treatment of the mass, right hepatic lobectomy was undertaken.

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