Ann Hepatobiliary Pancreat Surg.  2018 Aug;22(3):274-281. 10.14701/ahbps.2018.22.3.274.

Long-term complete response after transcatheter arterial chemoembolization and stereotactic body radiation therapy in a patient with hepatocellular carcinoma at the caudate lobe

• Chung YK
• Hwang S
• Ko GY
• Yoon SM

• KMID: 2420617
• DOI: http://doi.org/10.14701/ahbps.2018.22.3.274

Abstract

It is expected that a combination of transcatheter arterial chemoembolization (TACE) with stereotactic body radiation therapy (SBRT) may induce synergistic therapeutic effects in hepatocellular carcinoma (HCC), which would result in a high rate of complete therapeutic response. In this study, we present the 5-year clinical course of a patient who had HCC at the caudate lobe, which was treated with TACE and SBRT. A 53-year-old male was diagnosed with an 8 cm-sized HCC at the caudate lobe with compression of the inferior vena cava (IVC). For fear of pulmonary metastasis, we decided to perform sequential TACE-radiotherapy instead of upfront hepatectomy, although the tumor appeared resectable. The first session of TACE, SBRT with 12 fractions, and the second session of TACE were sequentially performed. The patient was administered metformin for chemoprevention. Over the course of a 5-year follow-up, there was no evidence of HCC recurrence. We reported the clinical sequence of a patient showing complete therapeutic response of HCC at the caudate lobe after a combination of TACE and radiotherapy. This type of combined locoregional treatment can be a therapeutic option for HCC at the caudate lobe with marginal resectability.

Keyword

Treatment response; Recurrence; Radiotherapy

MeSH Terms

Carcinoma, Hepatocellular*
Chemoprevention
Follow-Up Studies
Hepatectomy
Humans
Male
Metformin
Middle Aged
Neoplasm Metastasis
Radiotherapy
Recurrence
Therapeutic Uses
Vena Cava, Inferior
Metformin
Therapeutic Uses

Figure

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  Fig. 1 Computed tomography (CT) findings of the liver mass (A) at the caudate lobe taken 3 years before admission. This mass compresses the retrohepatic inferior vena cava (B).

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  Fig. 2 CT findings of the liver mass at the caudate lobe at admission with pre-enhancement phase (A), arterial phase (B), portal phase (C) and delayed phase (D).

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  Fig. 3 Magnetic resonance imaging showing a hypervascular mass (A) compressing the inferior vena cava (B).

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  Fig. 4 Positron emission tomography showed a vague and heterogeneously hypermetabolic mass.

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  Fig. 5 Hepatic arteriography shows the feeding arteries from the left hepatic artery (A) and post-embolization status (B).

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  Fig. 6 Liver CT scan of pre-enhancement (A) and arterial phase (B) taken 4 days after transcatheter arterial chemoembolization (TACE) shows a lipiodolized mass.

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  Fig. 7 CT simulation for stereotactic beam radiotherapy with avoidance of exposure to the gastric antrum.

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  Fig. 8 Liver CT scan of arterial phase (A, B) shows suspected viable tumor portion in the lipiodolized mass.

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  Fig. 9 Second session of transcatheter arterial chemoembolization shows suspicious tumor staining in both lobes (A) and post-embolization status.

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  Fig. 10 Follow-up CT scans showing no changes of the partial lipiodolized lesion at the caudate lobe taken 1 month (A), 1 year (B), 2 years (C), 3 years (D), 4 years (E) and 5 years (F) after the second session of TACE.

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