Transarterial chemoembolization (TACE) is one of treatment modalities which can give survival benefit to
patients with hepatocellular carcinoma (HCC) to which curative therapies can be applied. But, TACE can
encounter the risk of liver failure in case of HCC with main portal vein tumor thrombi. Advances in techniques
to account for respiration motion and understanding of partial liver tolerance to radiation therapy have permitted
us to deliver high dose radiation therapy without toxicity in treatment of HCC. We report a case of HCC with
massive portal vein thrombosis which responded to TACE following radiation therapy.
Hyun Young Woo, Jin Dong Kim, Jung Hyun Kwon, Chan Ran You, Jeong Won Jang, Si Hyun Bae, Jong Young Choi, Se Hyun Cho, Seung Kew Yoon, Dong Hoon Lee, Ho Jong Chun, Byung Gil Choi, Chul Seung Kay
Journal of the Korean Liver Cancer Study Group. 2008;8(1):124-127. Published online June 30, 2008
A 45-year-old man was admitted for the treatment of hepatocellular carcinoma (HCC). He was diagnosed
hepatitis B carrier 16 years ago and has not done a routine check. Abdominal CT showed a diffuse infiltrative
HCC involving right hepatic lobe with portal vein tumor thrombosis (PVTT) involving right portal vein and
proximal portion of left portal vein umbilical portion. With concurrent transcatheter arterial chemotherapy (TAC),
helical tomotherapy for portal vein thrombosis was done. With these treatments, main tumor and PVTT was
decreased in size markedly and no stain in hepatic angiogram. Due to repeated TAC, hepatic arterial stenosis
occurred and TAC was stopped. 3 months after, recurrent tumor was detected in MRI. Radiofrequency ablation
followed by High Intensity Focused Ultrasound (HIFU) was done for this recurrent mass. No viable mass was
shown in the follow up MRI done 6 months after HIFU.
We reported a 52-year-old women with hepatocellular carcinoma (HCC) of 10 cm in diameter involving entire
right lobe with advanced tumor thrombosis in the both branches and main trunk of portal vein. She was treated
with multimodal treatments resulting in a long-term survival of more than 5 years. At first, she was treated with
hepatic arterial chemotherapy (HAC) using cisplatin and 5-FU for 5 cycles and radiation therapy in September
2002. The tumor size decreased and the main and left portal vein thrombosis was disappeared. Although, she had
been treated with the 3th radiofrequency ablation (RFA) and the 3th transarterial chemoembolization (TACE) three
times for the treatment of main tumor, follow-up CT scan still showed marginal viable tumor at the segment 5.
Therefore, she was underwent right lobectomy of the liver and splenectomy. Further TACE was performed once
for the small remnant tumor around inferior vena cava at the postoperative 4 months. Finally, she has been
survived for over 5 years from the initial treatment and 23 months after operation without evidence of recurrence.
We suggest that the long-term survival was achieved in this patient through appropriate treatment selections at
the right time, such as HAC, RFA, TACE, hepatic resection and external radiotherapy based on changes in
diagnostic imaging and tumor markers.
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.
Kyung Woo Park, Joong-Won Park, Sang-Hyung Cho, Young Il Kim, Seong Hoon Kim, Hong Suk Park, Woo Jin Lee, Sang Jae Park, Dae Young Kim, Eun Kyoung Hong, Chang-Min Kim
Journal of the Korean Liver Cancer Study Group. 2005;5(1):37-41. Published online June 30, 2005
Recently, radiotherapy is considered as one of the palliative treatment modalities for patients with hepatocellular
carcinoma. In the adevent of 3-dimensional conformal radiotherapy, liver can be treated with high dose radiotherapy
without increment of complication. We report two cases of hepatocellular carcinoma with main portal vein
thrombosis, who were treated with 3D-CRT and showed promising outcome.