J Liver Cancer.  2022 Mar;22(1):51-56. 10.17998/jlc.2021.12.28.

Complete response to local therapy for advanced hepatocellular carcinoma with lung metastasis: a case report

Affiliations
  • 1Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
  • 2Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea

Abstract

The concept of oligometastasis is widely accepted for various types of solid tumors; accordingly, better outcomes can be anticipated with aggressive local interventions. The treatment of advanced hepatocellular carcinoma (HCC) with extrahepatic metastasis is systemic therapy. However, treatment responses to systemic therapy are poor. Recently, a small number of metastatic cancers (oligometastasis) have been controlled by local therapy rather than systemic therapy. Our study reports a case of a 66-year-old male patient with advanced HCC with lung metastasis, which was treated with local therapy. There were less than four metastases in the lungs, which were treated with wedge resection, radiofrequency, and radiation therapy. He repeatedly underwent local therapy for lung oligometastasis and locoregional therapy for intrahepatic HCC rather than systemic therapy; control by local therapy was possible as his liver function was preserved with Child-Turcotte-Pugh class A.

Keyword

Hepatocellular carcinoma; Oligometastasis; Transarterial chemoembolization; Radiofrequency ablation; Case report

Figure

  • Figure 1. A huge hepatocellular carcinoma (13 cm) in the right hepatic lobe is shown on initial liver magnetic resonance imaging. (A) T1W arterial phase. (B) Hepatobiliary phase (yellow arrow).

  • Figure 2. After initial treatment, chest computed tomography shows lung metastases (yellow arrows). (A) Left upper lung nodule. (B) Right lower lung nodule.

  • Figure 3. Radiofrequency ablation was performed on the subpleural lung metastasis. (A) Coronal view. (B) Sagittal view.

  • Figure 4. After approximately 6 years of initial treatment, chest computed tomography shows a slightly increased lymph node (arrow) size of 7×15.6 mm in the left internal mammary chain.

  • Figure 5. Serum tumor makers significantly decreased after initial treatment and mildly increased at the first relapse. (A) Alpha-fetoprotein (AFP). (B) Protein induced by the absence of vitamin K or antagonist-II (PIVKA-II).

  • Figure 6. Last computed tomography (CT) shows no evidence of hepatocellular carcinoma recurrence. (A) Liver CT. (B) Chest CT.


Reference

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