J Liver Cancer.  2022 Mar;22(1):63-68. 10.17998/jlc.2022.01.18.

Sorafenib combined with radiation therapy for advanced hepatocellular carcinoma with portal and hepatic vein invasion extending to the inferior vena cava: a complete response case according to modified RECIST criteria

• Cho Y
• Kim BH
• Kim TH
• Koh YH
• Park JW

• KMID: 2528298
• DOI: http://doi.org/10.17998/jlc.2022.01.18

Abstract

The prognosis of patients with advanced hepatocellular carcinoma (HCC) with tumor thrombus extending to the inferior vena cava (IVC) is extremely poor. Herein, we present a rare case of advanced HCC that was treated with sorafenib and radiotherapy, leading to complete remission. This patient had a 9 cm infiltrative HCC occupying almost the entire left lobe with a tumor thrombus extending through the hepatic vein, IVC, and left portal vein. The patient received 400 mg sorafenib twice daily. One year after the start of sorafenib, intensity-modulated radiation therapy for viable HCC and tumor thrombus was performed with a dose of 5,500 cGy. Twenty-seven months after the starting date of sorafenib, there was no intratumoral arterial enhancement, which suggested a complete response according to the modified RECIST criteria. This case suggests that the combination of sorafenib and radiotherapy might provide clinical benefits in patients with advanced HCC with IVC tumor thrombus.

Keyword

Hepatocellular carcinoma; Sorafenib; Radiotherapy; Complete remission; Case report

Figure

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  Figure 1 Initial liver dynamic computed tomography imaging findings. (A) Infiltrative hepatocellular carcinoma, left lobe lateral section with left hepatic vein in the arterial phase (red arrows). (B) Inferior vena cava tumor thrombus in the delayed phase (red arrow).

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  Figure 2 Follow-up liver dynamic computed tomography imaging findings after 1 year of sorafenib treatment. (A) Decreased size of infiltrative hepatocellular carcinoma, left lobe lateral section with left hepatic vein in the arterial phase (red arrows). (B) Decreased size and mass effect of inferior vena cava tumor thrombus in the delayed phase (red arrow).

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  Figure 3 Intensity modulated radiation therapy with Simultaneous integrated boost radiotherapy. Prescription dose to target volumes: planning target volume (PTV)-1, 5,500 cGy with 22 fractions; PTV-2, 4,400 cGy with 22 fractions.

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  Figure 4 Follow-up liver magnetic resonance imaging on hepatobiliary phase on May 2021. (A) Obliteration of Lt. portal vein and left hepatic vein in the hepatobiliary phase. (B) No tumor arterial phase enhancement and radiation-induced parenchymal change in atrophic liver left lateral section in the hepatobiliary phase.

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  Figure 5 Clinical course of the patient with alpha-fetoprotein (AFP), prothrombin induced by vitamin K absence (PIVKA)-II.

Reference

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