J Liver Cancer.  2019 Mar;19(1):64-68. 10.17998/jlc.19.1.64.

Liver Transplantation after Successful Downstaging with Hepatic Arterial Infusion Chemotherapy in a Patient with Hepatocellular Carcinoma with Portal Vein Tumor Thrombus

• Nam HC
• Sung PS
• Chun HJ
• Kim DG
• Jang JW
• Choi JY
• Yoon SK

• KMID: 2448279
• DOI: http://doi.org/10.17998/jlc.19.1.64

Abstract

Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide. The majority of patients with HCC are diagnosed at advanced disease stages with vascular invasion, where curative approaches are often not feasible. Currently, sorafenib is the only available standard therapy for HCC with portal vein tumor thrombosis (PVTT). However, in many cases, sorafenib therapy fails to achieve satisfactory results in clinical practice. We present a case of advanced HCC with PVTT that was treated with hepatic arterial infusion chemotherapy (HAIC) followed by liver transplantation. Three cycles of HAIC treatment resulted in necrotic changes in most of the tumors, and PVTT was reduced to an extent at which liver transplantation was possible. Further studies are required to determine the treatment strategies for advanced HCC with PVTT that can improve prognosis.

Keyword

Hepatocellular carcinoma; Venous thrombosis

MeSH Terms

Carcinoma, Hepatocellular*
Drug Therapy*
Humans
Liver Transplantation*
Liver*
Portal Vein*
Prognosis
Thrombosis*
Venous Thrombosis

Figure

• 

  Figure 1. Liver magnetic resonance imaging (MRI) findings. (A) Arterial phase, (B) portal venous phase, (C) hepatobiliary phase. MRI revealed a large infiltrative-type hepatocellular carcinoma in the right posterior hepatic section. The tumor showed heterogeneous enhancement pattern in the arterial phase (A). Portal venous tumor thrombus was observed in the portal venous phase (circle), extending up to the right main portal vein (B). Numerous daughter nodules were found as defects around the main tumor (C).

• 

  Figure 2. Follow-up liver magnetic resonance imaging (MRI) findings. (A) Arterial phase, (B) portal venous phase. Follow-up liver MRI demonstrated that the largest diameter of the mass was significantly reduced; arterial enhancement was observed only in the periphery of the tumor and internal necrosis was noted (A). The degree of the portal vein tumor thrombus, which initially extended to the right main portal vein, was also reduced to within the right posterior section of the portal vein (circle) (B).

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