J Liver Cancer.  2020 Sep;20(2):167-172. 10.17998/jlc.20.2.167.

Huge Hepatocellular Carcinoma Exhibiting a Complete Response after Stereotactic Body Radiation Therapy

• Shin KI
• Jang BK
• Kim JH
• Hwang JS

• KMID: 2508029
• DOI: http://doi.org/10.17998/jlc.20.2.167

Abstract

To date, there are limited data and little consensus on treatment strategies for huge hepatocellular carcinoma (HCC). Surgical resection provides significantly better survival than other modalities for single large HCC regardless of tumor stage. Recently, with technological advances in radiation therapy, stereotactic body radiation therapy (SBRT) is considered an alternative treatment option for HCC. Herein, we present a case of huge HCC that was successfully managed by SBRT. Transarterial embolization, previously performed in Russia, was incomplete. It was also not suitable for resection and transarterial chemoembolization. Although the rationale for radiotherapy in huge HCC was insufficient, SBRT was performed because no other treatment options were available. Additional radiofrequency ablation was performed for small HCC in a different segment, and radiological complete response (CR) was achieved. The CR was maintained over 4 years. Therefore, SBRT may be an alternative treatment option for large HCC that is not suitable for curative treatment.

Keyword

Hepatocellular carcinoma; Stereotactic body radiotherapy

Figure

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  Figure 1 Initial dynamic computed tomography scan findings. A single 12.2 cm wide mass in segment VIII-V showed enhancement in the arterial phase (A), and washout in the portal-phase (B) and the delayed phase (C).

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  Figure 2 Abdominal computed tomography scan obtained at our hospital. The hepatic mass grew up to 13.3 cm and a long and radiopaque material was inserted in the hepatic artery (arrow); thereby, occlusion of hepatic artery was noted.

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  Figure 3 Planning computed tomography scan for stereotactic body radiation therapy. We planned to target the entire hepatocellular mass.

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  Figure 4 Findings on follow-up dynamic computed tomography scan 5 months after stereotactic body radiation therapy. There was no viable hepatocellular lar carcinoma in segment VIII-V, but intrahepatic metastasis was present in segment VII (arrow).

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  Figure 5 Findings on follow-up dynamic computed tomography scan after stereotactic body radiation therapy (SBRT). Necrotic change without any enhancement was observed at the tumor site 5 months after SBRT (A). The necrotic lesion gradually decreased in size, and the complete response status was maintained for 1 year (B), 2 years (C), and 4 years (D) after SBRT.

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