Reserved liver function is one of the most important determinants of survivial in advanced
hepatocellular carcinoma (HCC). Especially in cirrhotic patient with decompensated liver
function, sorafenib for HCC with main portal vein invasion have limited efficacy and survival
benefit. Therefore many clinicians or centers still try locoregional therapy (LRT) such as
transarterial chemoembolization (TACE), radiation therapy (RT), or combination with LRT
and sorafenib in this situation. However this multidisciplinary approach may increase
treatment related toxicity such as liver failure, etc. Recently, studies for combination of RT
and sorafenib for HCC with portal vein invasion have been tried and reported not only better
therapeutic efficacy, but also more hepatic toxicity.Based on above suggestions, we herein
offer our experience of a patient that although achieved survival gain via partial remission
of intrahepatic tumor and main portal vein thrombosis and metastatic lymph node by
combination therapy of RT and sorafenib, finally expired due to hepatictoxicity. Further study,
maybe regarding a combination of locoregional and systemic therapy, is necessary on how to
manage decompenstated cirrhotic patients with HCC with main portal vein invasion. (J Liver
Cancer 2014;14:120-126)
Hepatocellular carcinoma (HCC) patients with main portal vein invasion have a poor prognosis associated with a median survival time of 2.7 months. Though many guidelines recommended sorafenib in HCC patients with macrovascular invasion (MVI), many clinicians or centers still select locoregional therapy (LRT) such as transarterial chemoembolization (TACE), radiation therapy (RT), or combination with LRT and sorafenib because the survival improvement by sorafenib only is expected to be shorter than that without MVI. However this multidisciplinary approach may increase treatment related toxicity such as liver failure etc. Stereotactic body radiation therapy (SBRT) is new technology providing very highly conformal ablative radiation dose for a small numbers (3-5 fractions) of large fraction size and is expected to new effective modality for HCC with MVI. Based on above suggestions, we herein offer our experience of a patient with perforation of radiation induced gastric ulcer after complete remission of tumor and main portal vein thrombosis by combination therapy of SBRT and sorafenib. Further study, maybe regarding a combination of locoregional and systemic therapy, is necessary on how to manage HCC patients with main portal vein invasion.
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Novel management of expected post-radiotherapy complications in hepatocellular carcinoma patients: a case report Sung Hoon Chang, Tae Suk Kim, Yong Hwan Jeon, Nuri Hyun Jung, Dae Hee Choi Journal of Liver Cancer.2022; 22(2): 183. CrossRef
A 57 year-old-male, who had a 40-year history of chronic alcohol dirnking, was referred to general weakness and jaundice for 1 month. Physical findings revealed that he had jaundice and spider angioma on anterior chest wall. The serum chemistries showed the total bilirubin 9.3 mg/dL and direct bilirubin level 6.1 mg/dL. The serum level of AST/ALT/AP was 130/192/494 IU/L. And the serum level of AFP was 18225.7 ng/ml. abdomen CT scan revealed the huge ill-defined hypodense mass was involving segment 2 and 3. The main portal vein and left portal vein were involved by this mass. Abdominal ultrasonography (US) showed huge echogenic mass in hilar portion of bile duct and tumor thrombosis in main and left portal vein. ERCP showed intraluminal-filling defect in CHD and complete obstruction of left IHD. We had a diagnosis this mass as hepatocellular carcinoma by US guided gun biopsy. Transcatheter arterial chemoembolization (TACE) was selected as the treatment due to TNM stage Ⅳa. After three times repeated TACE tumor decreased in size, regression of left portal vein invasion and normalization of jaundice, as a result, curative left lobectomy could be performed.