J Liver Cancer.  2022 Mar;22(1):57-62. 10.17998/jlc.2021.12.20.

A case report of advanced hepatocellular carcinoma treated with hepatic arterial infusion chemotherapy and sorafenib combination therapy followed by metastasectomy of lung and muscle metastases

• Moon SY
• Han SY
• Baek YH

• KMID: 2528297
• DOI: http://doi.org/10.17998/jlc.2021.12.20

Abstract

Currently, various tyrosine kinase inhibitors and immune checkpoint inhibitors have been suggested in the treatment guidelines for advanced hepatocellular carcinoma (HCC). However, sorafenib was the only systemic drug approved 10 years ago. In 2010, a woman diagnosed with HCC rupture and multiple lung metastases visited our hospital. At the time of visiting our hospital, she had undergone transarterial chemoembolization at another hospital to control bleeding due to HCC rupture. We treated her with hepatic arterial infusion chemotherapy and sorafenib combination therapy to increase the control of intrahepatic tumors in consideration of the modest efficacy of sorafenib. The intrahepatic tumor was almost controlled. Metastasectomy was performed to control lung oligometastasis. Subsequently, additional muscle metastasis was confirmed, and metastasectomy was performed. Although this is a very rare case, it shows that a multidisciplinary approach can improve the prognosis of patients with HCC.

Keyword

Hepatocellular carcinoma; Intraarterial infusion; Metastasectomy; Case report

Figure

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  Figure 1. Computed tomography (CT) at the first diagnosis of hepatocellular carcinoma in August 2010. Abdominal CT showed multiple hypervascular masses in both lobes, extravasation of contrast media from the left lobe (yellow arrow), and hemoperitoneum in the arterial phase (A, B). Chest CT showed multiple lung metastases (red arrows) (C, D).

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  Figure 2. Computed tomography (CT) followed by 15 cycles of hepatic artery infusion chemotherapy and daily sorafenib administration in February 2012. Abdominal CT showed no viable tumor exhibiting enhancement in the liver in the arterial phase (A, B). Chest CT showed three nodules in both lower lobes. The left nodule (yellow arrow) was too small to identify definite viability. Thus, metastasectomy was only performed for the two nodules (red arrow) in the right lower lobe (C-E). Positron emission tomography CT showed a mild hypermetabolism in the S8 lesion that had been previously treated with transarterial chemoembolization, but only necrotic change with fibrous tissue was identified by biopsy (F).

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  Figure 3. Abdominal computed tomography in October 2016, showing recurred hepatocellular carcinoma with a size of 25 mm and contrast enhancement in the arterial phase (red arrow) (A). Washout in the delayed phase (B) was found in the S5/6 lesion.

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  Figure 4. A thigh magnetic resonance imaging (MRI) was performed because a mass was felt on the right thigh from 1 year ago. T2-weighted MRI showed a heterogeneous signal intense mass, which was not observed to communicate with other muscles or soft tissues (A). Muscle metastasis taken before resection in the operating room (B).

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  Figure 5. Summary of treatment course and changes in serum alpha-fetoprotein (AFP) levels. HAIC, hepatic arterial infusion chemotherapy; Rt., right; Lt., left; SMM, semimembranous muscle.

Reference

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