Although chemotherapy may not play a central role in the treatment of hepatocellular carcinoma (HCC), it must be one of the
important possibilities of multimodal treatment for advanced HCC. Intra-arterial (IA) chemotherapy which can deliver high
concentration of drug to the tumor has been widely used in unresectable or intractable HCC. It seems to reduce the incidence of
systemic side effects and improve drug efficacy. For this therapy, catheter implantation is required to infuse anti-tumor drug.
Here, we report a case of patient with complication developed during IA chemotherapy for advanced HCC with portal vein
thrombosis.
Jong Kyu Park, Young Seok Kim, Sang Gyune Kim, Seung Won Jeong, Jae Young Jang, Hyun Jong Choi, Jong Ho Moon, Hong Soo Kim, Moon Sung Lee, Chan Sup Shim, Boo Sung Kim
Journal of the Korean Liver Cancer Study Group. 2009;9(1):49-52. Published online June 30, 2009
Recent progress in imaging techniques has permitted the diagnosis of hepatocelluar carcinoma (HCC) at an early stage.
However, portal vein invasion is still found in 12.5~39.7%. HCC with tumor thrombosis of the portal vein has a poor
prognosis. Previous studies showed that the median survival time of patients with HCC with involving portal vein was 2.7~4
months if effective treatment was not administered. Thus, for such HCC with portal vain invasion, an effective therapy that
will maintain quality of life is required. We report a case of HCC with portal vein tumor thrombus treated by intra-arterial
chemotherapy.
Advanced hepatocellular carcinoma has a poor prognosis, especially in the case of advanced hepatocelluar
carcinoma with portal vein thrombosis. In such cases, variable therapeutic modalities have been tried to improve
the prognosis. Intra-arterial chemotherapy is one of these modalities, but the effect of this therapeutic modality
is unclear. We report two cases of good response after intra-arterial chemotherpy in patients with advanced
hepatocellular carcinoma.
A 44 year-old-male patient was admitted to our hospital for evaluation of hepatic mass which was detected on ultrasonography. On serologic and tumor marker study, HBeAg was positive, AFP was 570 mg/mL. Liver function test was normal. Abdomen CT showed less enhanced hepatic mass on 4, 5 and left portal vein thrombosis. Hepatocellular carcinoma was confirmed with biopsy and we treated the patient with transarterial chemoembolization (TACE). CT scan taken 2 weeks after TACE showed the aggravation of portal vein thrombosis and Lipiodol was washed out. After 1 month after TACE, we could not perform any more TACE because portogram showed both portal veins were occluded. CT showed new mass on S 6. We inserted chemoport catheter to proper hepatic artery and started intra-arterial chemotherapy(5-FU 250 mg and cisplatin 10 increased. But after the 2nd cycle of IACT, tumor size was decreased and after the 3rd cycle tumor on S 6 was disappeared. After the 4th cycle, tumor on S 4, 5 was disappeared. We have tried totally 6 cycles of IACT and CT taken after the 6th IACT showed no tumor mass and no portal vein thrombosis. Serum AFP level was rapidly dropped and remained less than 2.0 ng/dL after the 4th cycle. We followed the patient for 14 months after the 6th cycle and there was no evidence of residual tumor with image and tumor marker study.
A 52 year-old-male patient was admitted to our hospital due to hematemesis. Ten years ago, he had been diagnosed chronic hepatitis B and he was heavy alcoholics. He was in the state of SB tube insertion and we had esophagogastroduodenoscopy and found out cardiac varix bleeding and injected history1. On abdominal ultrasonograpy, large hypoechoic mass in left lobe of liver was noted and the mass invaded into hepatic vein, inferior vena cava (IVC), and right atrium. On hepatic arteriography, large hypervascular mass in left lobe of the liver and several small dodules in right lobe were noted. We performed chemoembolization to the nodules in right lobe but cannot performed to the lesion in left love due to arteriovenous shunt. We inserted the chemport catheter to proper hepatic artery and started the intra-arterial chemotherapy (IACT) with 5-FU 250 mg and cisplatin 10 mg for 5 days. After the second cycle of IACT, tumor thrombus in right atrium was disappeared and thrombus in IVC and tumor mass in left lobe were decreased in size. We believed that hepatocellular carcinoma of this patient should be sensitive to chemotherapy and planned the additional IACT treatment.