Hepatocellular carcinoma (HCC) patients with bile duct invasion have a poor prognosis because many do not receive effective treatment. Surgical resection is thought to be only option of curative treatment, increasing chance of survival, but it is possible to minor group of patients because of poor reserved liver function associated with underlying liver disease and obstructive jaundice. Therefore many clinicians or centers still select locoregional therapy such as transarterial chemoembolization (TACE), radiation therapy (RT) etc. Stereotactic body radiation therapy (SBRT) is new technology providing very highly conformal ablative radiation dose for a small numbers (1-5 fractions) of large fraction size and is expected to salvage modality for HCC showed incomplete response of TACE due to vascularity or accessibility of feeding artery. Based on above suggestions, we herein offer our experience of a patient with partial remission of tumor by combination therapy of TACE, SBRT and sorafenib. Further study, maybe regarding a combination of locoregional and systemic therapy (so called multidisciplinary approach), is necessary on how to manage HCC patients with bile duct invasion or sparse vascularity.
Extrahepatic metastasis (EHM) associated with hepatocellular carcinoma (HCC) has been increasing due to prolonged
survival with recent advances in therapeutic approaches including locoregional therapy such as transarterial chemoemoblization
(TACE), radiofrequency ablation and radiation therapy (RT). Though many guidelines recommended systemic therapy such as
sorafenib in this situation, some clinicians or centers still select locoregional therapy because the survival improvement of 2 or 3
months by sorafenib is far from optimal. Moreover, some studies showed that complete and partial response of intrahepatic
tumors can result in significant improvement of patient survival even in situation of EHM. Based on above suggestions, we herein
offer our experience of a patient with complete remission of intrahepatic tumor and adrenal gland metastasis treated with
combination therapy of TACE and RT and sorafenib. Further study, maybe regarding a combination of locoregional and systemic
therapy (so called multidisciplinary approach), is necessary on how to manage HCC patients with EHM.
Hemolytic uremic syndrome (HUS) is a rare condition compromising the clinical triad of acute renal failure, microangiopathic
hemolytic anemia, and thrombocytopenia. HUS may be associated with a variety of etiologies, and chemotherapeutic agents have
also been reported to be associated with HUS, including mitomycin, cisplatin, bleomycin, and most recently gemcitabine. HUS
also has been observed in association with a number of disseminated malignancies in adults, most typically adenocarcinoma of
the stomach and breast. But there was no case report of HUS after cisplatin based transarterial chemoembolization (TACE) for
hepatocellular carcinoma (HCC). We experienced a case of HUS after cisplatin based TACE and reported this case with several
literature reviews.