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J Liver Cancer > Volume 14(1); 2014 > Article
Journal of the Korean Liver Cancer Study 2014;14(1):46-52.
DOI: https://doi.org/10.17998/jlc.14.1.46    Published online March 31, 2014.
A Case of Perforation of Gastric Ulcer after Complete Remission of Huge Hepatocellular Carcinoma Invading Main Portal Vein with Combination Therapy of Stereotactic Body Radiation Therapy and Sorafenib
Sang Youn Hwang1, Seon-Mi Lee1, Jung Woo Im1, Joon Suk Kim1, Sang Bu Ahn2, Eun Kyeong Ji2, Chul Won Choi3, Gwang-Mo Yang3
1Departments of Internal Medicine and Gastrointestinal Cancer Center, Dongnam Institute of Radiological and Medical Sciences, Busan, Korea
2Departments of Radiology, Dongnam Institute of Radiological and Medical Sciences, Busan, Korea
3Departments of Radiation Oncology, Dongnam Institute of Radiological and Medical Sciences, Busan, Korea
Copyright ©2014 by The Korean Liver Cancer Association
Abstract
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.
Key Words: Hepatocellular carcinoma; Portal vein invasion; Stereotactic body radiotherapy; Sorafenib; Gastric ulcer perforation
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