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

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


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.


Hepatocellular carcinoma


  • 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.


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