J Liver Cancer.  2019 Sep;19(2):159-164. 10.17998/jlc.19.2.159.

Hepatocellular Carcinoma with Segmental Portal Vein Invasion Exhibiting a Complete Response after Transarterial Radioembolization

• Yoon JS
• Yu SJ
• Lee YB
• Cho EJ
• Lee JH
• Kim YJ
• Yoon JH

• KMID: 2463618
• DOI: http://doi.org/10.17998/jlc.19.2.159

Abstract

The treatment options available for patients with hepatocellular carcinoma (HCC) with portal vein invasion (PVI) include sorafenib, transarterial radioembolization (TARE), radiation therapy (RT), transarterial chemoembolization with RT, and proton beam irradiation. Herein, we present a case of HCC with segmental PVI that was managed via TARE. The patient had a 4 cm HCC that invaded the segment VIII portal vein branch without extrahepatic spread. Liver function was Child-Pugh grade A, and performance status was good. TARE was performed without any adverse events, and a radiological complete response (CR) was achieved. Thereafter, the patient was followed-up every 3-6 months without any further treatment, and the CR was maintained for >3 years. Therefore, TARE may be a useful alternative therapeutic option for patients with HCC exhibiting segmental PVI.

Keyword

Hepatocellular carcinoma; Venous thrombosis; Radiotherapy; Therapeutic embolization; Yttrium-90

MeSH Terms

Carcinoma, Hepatocellular*
Embolization, Therapeutic
Humans
Liver
Portal Vein*
Protons
Radiotherapy
Venous Thrombosis
Protons

Figure

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  Figure 1. Initial dynamic computed tomography findings. A single 4 cm mass in segments VII/VIII exhibited enhancement in the arterial phase (A), and washout in the portal-phase (B) and the delayed phase (C) (arrow).

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  Figure 2. Magnetic resonance imaging findings. The mass showed low signal intensity on unenhanced T1-weighted imaging (A). In the dynamic phase, the mass exhibited enhancement in the arterial phase (B), and washout in the portal-phase (C) and the hepatobiliary phase (D). The tumor thrombus involved the segment VIII portal vein branch (arrow). The thrombus extended directly from the tumor and exhibited enhancement in the arterial phase, and washout in the portal- and hepatobiliary phases.

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  Figure 3. Hepatic angiography findings. Hepatic angiography revealed a hypervascular tumor in segments VII/VIII (arrow). The anatomy of the hepatic artery was normal; extrahepatic accessory arteries were absent.

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  Figure 4. Findings on follow-up dynamic computed tomography after transarterial radioembolization (TARE). Low-attenuated necrotic change without any enhancement (a complete response [CR]) was observed at the tumor site two months after TARE (A). The necrotic lesion gradually decreased in size, and the CR status was maintained for 1 year (B), 2 years (C), and 3 years (D) after TARE (arrow).

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