J Liver Cancer.  2019 Sep;19(2):149-153. 10.17998/jlc.19.2.149.

Long-term Disease-free Survival after Trimodality Treatment of Recurrent Hepatocellular Carcinoma Involving the Inferior Vena Cava and Right Atrium

• Park S
• Yoon WS
• Yim HJ
• Rim CH

• KMID: 2463616
• DOI: http://doi.org/10.17998/jlc.19.2.149

Abstract

Hepatocellular carcinoma (HCC) involving the inferior vena cava (IVC) and/or right atrium (RA) is a rare and intractable disease. A standard treatment has not been established yet, owing to the rarity of disease and difficulties in the therapeutic treatment. Herein, we report the case of a patient who had recurrent HCC (after a prior lobectomy) involving both IVC and RA and underwent multimodality treatments including external beam radiotherapy and transarterial chemotherapy, followed by sorafenib treatment. The disease was well controlled with local treatments and sustained for 7 years until last follow-up after the systemic treatments. Our case shows a possibility of long-term survival for patients affected by HCC involving IVC and/or RA, after a rigorous multimodality treatment strategy.

Keyword

Liver neoplasm; Inferior vena cava; Right atrium; Radiotherapy

MeSH Terms

Carcinoma, Hepatocellular*
Disease-Free Survival*
Drug Therapy
Follow-Up Studies
Heart Atria*
Humans
Liver Neoplasms
Radiotherapy
Vena Cava, Inferior*

Figure

• 

  Figure 1. Imaging studies at the initial diagnosis and at different follow-ups. (A) Liver magnetic resonance imaging at the initial diagnosis. A mass 12 cm in size was noted in the right lobe of the liver. The tumor showed arterial enhancement and a delayed washout pattern. (B) Two years after the surgery, HCC recurred in segment 4 with tumor thrombus in the inferior vena cava (IVC) and right atrium (RA). (C) Three months after external beam radiotherapy (EBRT) and 3 cycles of transarterial chemotherapy (TACE), the thrombus in the RA disappeared, the IVC was well-lipiodolized, but a filling defect was seen around the IVC. Sorafenib was administered after EBRT and TACE. (D) Three years and 4 months post-TACE and EBRT followed by sorafenib, recurrence at segment 3 was observed. (E) Radiofrequency ablation (RFA) was performed and a good ablation was seen in the follow-up image 3 months after the RFA.

• 

  Figure 2. External beam radiotherapy planning to treat the tumor at segment 4 with a right atrium and inferior vena cava thrombus. (A) Scheme of the radiation dose distribution. (B) Dose-volume histogram showing the doses received by organs and the relevant volumes.

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