J Liver Cancer.  2020 Mar;20(1):78-83. 10.17998/jlc.20.1.78.

A Case of Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis Treated by Hepatic Arterial Infusion Chemotherapy and Radiotherapy

• Lee JY
• Yoo JJ
• Chun SJ
• Bae SH
• Lee JM
• Kim SG
• Kim YS

• KMID: 2505846
• DOI: http://doi.org/10.17998/jlc.20.1.78

Abstract

Sorafenib is the standard treatment for advanced hepatocellular carcinoma (HCC) with portal vein thrombosis (PVT). Additionally, hepatic arterial infusion chemotherapy has been used as a treatment option for advanced HCC. Here, we report a case of sustained partial response in a patient with advanced HCC with PVT after hepatic arterial infusion chemotherapy and radiation therapy.

Keyword

Hepatocellular carcinoma; Chemotherapy; Radiotherapy

Figure

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  Figure 1. Baseline computed tomography imaging. In segment 5/6, a round heterogeneous enhanced mass with an irregular margin was observed in the (A) arterial phase followed by iso-attenuation in the (B) portal phase and the (C) venous phase. In contrast, the portal vein (PV) thrombus in the right hepatic vein was slightly hypointense (C). PV tumor thrombosis was enhanced in the main PV (D).

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  Figure 2. Baseline magnetic resonance imaging (MRI). Liver MRI findings: infiltrative hepatocellular carcinoma was observed in the right hepatic lobe with a tumor nodule in segment 5/6. The lesion was ill-defined with high attenuation in the right hepatic lobe in (A) the arterial phase followed by wash-out in the portal delayed and portal venous phase (B, C). In addition, a portal vein tumor thrombus was observed in the hepatobiliary phase (D).

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  Figure 3. Follow-up computed tomography (CT) finding after six months. CT and showed marked improvement in the infiltrative hepatocellular carcinoma (HCC) in the right lobe with a decrease in the size of the infarcted HCC in segment 5/6 (A-C). In addition, the size of the extensive portal vein thrombosis decreased in the main vein and both portal veins (D).

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  Figure 4. Follow-up computed tomography (CT) finding after 27 months. Follow-up CT imaging was performed 27 months from the first hepatic arterial infusion chemotherapy treatment and 16 months after transarterial chemoembolization. The last follow-up imaging showed a stable state and improved infiltrative hepatocellular carcinoma (HCC) in the right lobe, infarcted HCC in the segment 5/6, and decreased tumor thrombosis in both portal veins (A, B) as compared to the initial CT findings at (C, D).

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