J Liver Cancer.  2020 Sep;20(2):160-166. 10.17998/jlc.20.2.160.

Advanced Stage Hepatocellular Carcinoma Successfully Treated with Transarterial Radioembolization and Multi-tyrosine Kinase Inhibitor Therapy

• Goh MJ
• Kang W
• Sinn DH
• Gwak GY
• Paik YH
• Choi MS
• Lee JH
• Koh KC
• Paik SW

• KMID: 2508028
• DOI: http://doi.org/10.17998/jlc.20.2.160

Abstract

Transarterial radioembolization (TARE) with yttrium-90 microspheres has become widely utilized in managing hepatocellular carcinoma (HCC). The utility of TARE is expanding with new insights through experiences from real-world practice and clinical trials, and recently published data suggest that TARE in combination with sorafenib may improve the overall survival in selected patients. Here, we report a case of advanced stage HCC that was successfully treated with TARE and sorafenib. The patient achieved complete response (CR) at 12 months after the initial treatment with TARE and sorafenib, followed by additional transarterial chemoembolization and proton beam therapy for local tumor recurrence at 19-month post-TARE. The patient was followed up every 3 months thereafter and still achieved CR both biochemically and radiologically for the following 12 months. A combination strategy of TARE and systemic therapy may be a useful alternative treatment option for selected patients with advanced stage HCC.

Keyword

Hepatocellular carcinoma; Yttrium-90; Radioembolization; Sorafenib; Tyrosine kinase inhibitor

Figure

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  Figure 1 Initial liver dynamic magnetic resonance image findings. Multinodular mass showed enhancement on the arterial phase (A) and washout on the portal phase (B–D). The tumor thrombosis involved in the portal vein branches and mid-hepatic vein (arrows). (E) Initial chest computed tomography findings. Multiple pulmonary metastases in both lungs were observed.

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  Figure 2 Follow-up liver dynamic computed tomography (CT) findings at 1-month (A), 3-month (B), 6-month (C), and 12-month (D) post-transarterial radioembolization (TARE). Follow-up chest CT findings at 1-month (E), 3-month (F), 6-month (G), and 12-month (H) post-TARE.

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  Figure 3 Follow-up liver dynamic magnetic resonance imaging at 19-month post-transarterial radioembolization showing a subcentimeter-sized enhancing viable tumor at the top of segment 8/4 lesion on the arterial phase (A) with diffusion restriction (B). A focal hypermetabolic lesion (maximum standardized uptake value [SUVmax]=5.3) at the corresponding lesion in positron emission tomography-computed tomography (C). Hepatic angiography. Multiple punctate tumor stainings at segment 8/4 were observed (D).

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  Figure 4 Clinical progress including treatment modalities, treatment response, and change in tumor markers (bottom) during the follow-up period. Mon, months; TARE, transarterial radioembolization; TACE, transarterial chemoembolization; PBT, proton beam therapy; PD, progressive disease; PR, partial response; CR, complete response; AFP, alpha-fetoprotein.

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