Journal of Liver Cancer

Case Report

A case report of advanced hepatocellular carcinoma treated with hepatic arterial infusion chemotherapy and sorafenib combination therapy followed by metastasectomy of lung and muscle metastases: Sang Yi Moon, Sang Young Han, Yang-Hyun Baek; J Liver Cancer. 2022;22(1):57-62. Published online January 6, 2022; DOI: https://doi.org/10.17998/jlc.2021.12.20

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Abstract PDF: Currently, various tyrosine kinase inhibitors and immune checkpoint inhibitors have been suggested in the treatment guidelines for advanced hepatocellular carcinoma (HCC). However, sorafenib was the only systemic drug approved 10 years ago. In 2010, a woman diagnosed with HCC rupture and multiple lung metastases visited our hospital. At the time of visiting our hospital, she had undergone transarterial chemoembolization at another hospital to control bleeding due to HCC rupture. We treated her with hepatic arterial infusion chemotherapy and sorafenib combination therapy to increase the control of intrahepatic tumors in consideration of the modest efficacy of sorafenib. The intrahepatic tumor was almost controlled. Metastasectomy was performed to control lung oligometastasis. Subsequently, additional muscle metastasis was confirmed, and metastasectomy was performed. Although this is a very rare case, it shows that a multidisciplinary approach can improve the prognosis of patients with HCC.

Original Article

A Case of Hepatocellular Carcinoma with Recurrent Peritoneal Metastasis after Hepatectomy Who Showed Complete Response by Surgical Resection: Hyo Young Lee, Jeong-Hoon Lee, Joon Yeul Nam, Young Chang, Hyeki Cho, Young Youn Cho, Eung Ju Cho, Su Jong Yu, Yoon Jun Kim, Jung-Hwan Yoon; J Liver Cancer. 2017;17(2):153-157. Published online September 30, 2017; DOI: https://doi.org/10.17998/jlc.17.2.153

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Abstract PDF: Recurrence of hepatocellular carcinoma (HCC) after hepatic resection is quite common. Peritoneal recurrence has been considered incurable status and related to poor prognosis. Although peritoneal metastasectomy is a therapeutic option for some selected patients with a few peritoneal metastasis, the indication and therapeutic effect has not been clear. We report a
case
of a 61-year-old man achieving complete remission of recurrent peritoneal metastasis after repeated surgical resection by a multidisciplinary approach. Peritoneal metastasectomy might be a therapeutic option for selected patients with localized oligonodular peritoneal metastasis.

Case Reports

A Case of Surgical Resection in Hepatocellular Carcinoma with Pulmonary Metastasis: Woo Jin Jung, Jae Young Jang, Jun Seok Park, Hee Jeong Lee, Young Kyu Cho, Soung Won Jeong, Sae Hwan Lee, Snag Gyune Kim, Sang Woo Cha, Young Seok Kim, Young Deok Cho, Hong Soo Kim, Boo Sung Kim; J Liver Cancer. 2016;16(2):145-150. Published online September 30, 2016; DOI: https://doi.org/10.17998/jlc.16.2.145

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Abstract PDF: Hepatocellular carcinoma (HCC) is well known malignancy with poor prognosis, even after resection of the primary tumor. Sorafenib is the first-line treatment in advanced HCC, but the disease control rate of sorafenib is only 43%. Pulmonary metastasectomy in patients with pulmonary metastasis from HCC has been reported to increase long-term survival compared with systemic chemotherapy. Video-assisted thoracic surgery is considered a reliable approach to the diagnosis and treatment of pulmonary diseases with low complication rate. Pulmonary metastasectomy is not universally accepted because of frequent local recurrence, an uncontrollable primary tumor, and frequent multiple pulmonary metastases in HCC, but outcome of pulmonary metastasectomy and adjuvant sorafenib therapy has not been studied. We experienced a patient who had advanced HCC with pulmonary oligometastasis and received surgical resection of the metastatic pulmonary nodule and sorafenib chemotherapy. In advanced HCC with pulmonary oligometastasis, surgical resection of pulmonary metastasis and sorafenib chemotherapy should be considered.

A Case of Complete Remission in Patient with Extrahepatic Metastasis after Curative Resection of Hepatocellular Carcinoma by Radiotherapy, Lung Resection and Systemic Chemotherapy: Yeong Jin Kim, Hye won Lee, Ji Hoon Lee, Jin Sil Sung, Do Young Kim; J Liver Cancer. 2016;16(1):63-66. Published online March 31, 2016; DOI: https://doi.org/10.17998/jlc.16.1.63

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Abstract PDF: Surgical resection is mainstay treatment of hepatocellular carcinoma (HCC). However, its prognosis is poor, because of the high incidence of HCC recurrence (cumulative 5-year HCC recurrence rate of 70-80%). The most common site of HCC recurrence is the remnant liver, and extrahepatic recurrence occurs in 6.7-13.5% of patients. Because the tumor characteristics in extrahepatic recurrence are usually multiple and aggressive, the optimal treatment modality has not yet been determined. We report a case of complete remission and long term survival over 60 months in patient with extrahepatic metastasis after curative resection of HCC by aggressive treatment, which include lung resection for lung metastasis, radiotherapy for mediastinal lymph node metastasis, and systemic chemotherapy.

Review Article

Current Experience of Metastasectomy of HCC - When and for Whom?: Sang Jae Park; Journal of the Korean Liver Cancer Study Group. 2008;8(1):8-11. Published online June 30, 2008

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Abstract PDF: Intrahepatic (IH) metastasis is more frequent but extrahepatic (EH) metastasis results in worse prognosis and proper treatment on IH and EH metastasis is essential for improving the long-term survival. The purpose of this report is to review the current experience of EH metastasectomy and also to review the results of re-hepatectomy on IH metastasis after hepatectomy of HCC. EH metastasis can occur in lung, lymph nodes, bone, adrenal gland and brain in frequency. Indications of EH metastatectomy of HCC are 1) cured or controlled IH lesion, 2) acceptable operation risk, 3) complete removal of EH lesions seems possible. After lung metastasectomy, 5-year survival rates in previous reports are 23-67% according to the indications. The poor prognosis factors after lung metastasectomy are short disease-free interval between hepatectomy and lung resection, high alpha-fetoprotein. In selected patients with EH metastasis of HCC, long-term survival can be achieved by proper and aggressive surgery. The 5-year recurrence rate after hepatectomy of HCC ranges 60-100% and more than half of them is IH recurrence. IH recurrence can be classified to IH metastasis and multicentric occurrence (MO) by mode of recurrence, and MO is known to be related to HCV infection, long disease-free interval and better survival. Though it is impossible to discriminate IH metastasis and MO, re-hepatectomy should be considered in patients with single nodule recurrence and with more than 1-year of disease-free survival after hepatectomy of HCC.

Case Report

A Case of Successful Pulmonary Resection in Patient with Lung Metastasis of Hepatocellular Carcinoma: Ik Yoon, Hyung Joon Yim, Jin Nam Kim, Sun Min Park, Jeong Han Kim, Seung Hwa Lee, Ju-Han Lee, Hwan-Hoon Chung, Hong Sik Lee, Hyung Joo Park, Sang Woo Lee, Jai Hyun Choi; Journal of the Korean Liver Cancer Study Group. 2008;8(1):81-85. Published online June 30, 2008

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Abstract PDF: Lung is the most common site of extrahepatic metastasis from hepatocellular carcinoma (HCC). Until now, there have been few reports about surgical resection for pulmonary metastasis from HCC, but the role and the indication of surgery for pulmonary metastasis remains unclear. We report a case of advanced HCC with pulmonary metastasis, which was effectively treated by metastasectomy. A 45-year-old male patient who had received TACE (transarterial chemoembolization) 14 times for hepatocellular carcinoma was found to have solitary metastasis in the right hilar area of the lung. Surgical metastasectomy was performed and pulmonary metastatic nodule was successfully removed. Primary tumor in the liver was effectively treated with TACE and follow-up CT (computed tomography) showed no viable tumor in the liver and the lung.

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