Kosin Med J.  2021 Dec;36(2):161-168. 10.7180/kmj.2021.36.2.161.

Efficacy of Hepatic Arterial Infusion Chemotherapy and Radiofrequency Ablation against Hepatocellular Carcinoma Refractory to Transarterial Chemoembolization and Vascular Variation: A Case Study

Affiliations
  • 1Department of Internal Medicine, On hospital, Busan, Republic of Korea
  • 2Department of Internal Medicine, Dong-A University College of Medicine, Busan, Republic of Korea

Abstract

Transarterial chemoembolization is often the first-line treatment for multiple hepatocellular carcinomas. However, hepatic arterial infusion chemotherapy is a treatment option for hepatocellular carcinoma refractory to multiple sessions of transarterial chemoembolization. Hepatic arterial infusion chemotherapy requires implantation of an appropriate port into the hepatic artery. However, it may be impossible to implant a port due to hepatic artery variation. We report a case of hepatocellular carcinoma refractory to transarterial chemoembolization and hepatic artery variation treated successfully with hepatic arterial infusion chemotherapy and radiofrequency ablation with complete response after implantation of ports in both liver lobes.

Keyword

Hepatocellular carcinoma

Figure

  • Fig. 1 Hepatic dynamic magnetic resonance imaging findings (July 2019). Multiple nodules in both hepatic lobes show enhancement in the arterial phase (A), and washout in hepatobiliary phase (B). Three benign hepatic hemangiomas were homogenous with high-intensity signals on T2-weighted image (C).

  • Fig. 2 Patient’s vascular variation indicates direct branching of the right hepatic artery through the celiac trunk (A) and the left hepatic artery branching through the common hepatic artery (B). We implanted a port into the right hepatic artery through the right femoral artery and another port into the left hepatic artery through the left femoral artery (C).

  • Fig. 3 A follow-up liver dynamic magnetic resonance imaging in January 2020, revealed increase in the size of S5 lesion from 10 mm to 15 mm, and no other masses were observed.

  • Fig. 4 A follow-up liver dynamic magnetic resonance imaging in April 2020 revealed no recurrence of HCC, after a single RFA and 6 cycles of HAIC.


Reference

1. Yang JD, Hainaut P, Gores GJ, Amadou A, Plymoth A, Roberts LR. A global view of hepatocellular carcinoma: trends, risk, prevention and management. Nat Rev Gastroenterol Hepatol. 2019; 16:589–604.
Article
2. Llovet JM, Zucman-Rossi J, Pikarsky E, Sangro B, Schwartz M, Sherman M, et al. Hepatocellular carcinoma. Nat Rev Dis Primers. 2016; 2:16018.
Article
3. Marrero JA, Kulik LM, Sirlin CB, Zhu AX, Finn RS, Abecassis MM, et al. Diagnosis, Staging, and Management of Hepatocellular Carcinoma: 2018 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology. 2018; 68:723–50.
Article
4. Kudo M, Matsui O, Izumi N, Kadoya M, Okusaka T, Miyayama S, et al. Transarterial chemoembolization failure/refractoriness: JSH-LCSGJ criteria 2014 update. Oncology. 2014; 87:Suppl 1. 22–31.
Article
5. Kodama K, Kawaoka T, Aikata H, Uchikawa S, Inagaki Y, Hatooka M, et al. Comparison of clinical outcome of hepatic arterial infusion chemotherapy and sorafenib for advanced hepatocellular carcinoma according to macrovascular invasion and transcatheter arterial chemoembolization refractory status. J Gastroenterol Hepatol. 2018; 33:1780–6.
Article
6. Chon YE, Lee HA, Yoon JS, Park JY, Kim BH, Lee IJ, et al. Hepatocellular Carcinoma in Korea between 2012 and 2014: an Analysis of Data from the Korean Nationwide Cancer Registry. J Liver Cancer. 2020; 20:135–47.
Article
7. Ueshima K, Ogasawara S, Ikeda M, Yasui Y, Terashima T, Yamashita T, et al. Hepatic Arterial Infusion Chemotherapy versus Sorafenib in Patients with Advanced Hepatocellular Carcinoma. Liver Cancer. 2020; 9:583–95.
Article
8. Ikeda M, Morizane C, Ueno M, Okusaka T, Ishii H, Furuse J. Chemotherapy for hepatocellular carcinoma: current status and future perspectives. Jpn J Clin Oncol. 2018; 48:103–14.
Article
9. Ensminger WD, Rosowsky A, Raso V, Levin DC, Glode M, Come S, et al. A clinical-pharmacological evaluation of hepatic arterial infusions of 5-fluoro-2′-deoxyuridine and 5-fluorouracil. Cancer Res. 1978; 38:3784–92.
10. Song DS, Bae SH, Song MJ, Lee SW, Kim HY, Lee YJ, et al. Hepatic arterial infusion chemotherapy in hepatocellular carcinoma with portal vein tumor thrombosis. World J Gastroenterol. 2013; 19:4679–88.
Article
11. Ricke J, Hildebrandt B, Miersch A, Nicolaou A, Warschewske G, Teichgräer U, et al. Hepatic arterial port systems for treatment of liver metastases: factors affecting patency and adverse events. J Vasc Interv Radiol. 2004; 15:825–33.
Article
12. Qi X, Tang Y, An D, Bai M, Shi X, Wang J, et al. Radiofrequency Ablation Versus Hepatic Resection for Small Hepatocellular Carcinoma: A Meta-analysis of Randomized Controlled Trials. J of Clin Gastroenterol. 2014; 48:450–7.
Full Text Links
  • KMJ
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr