J Liver Cancer.  2022 Mar;22(1):84-90. 10.17998/jlc.2022.03.07.

Long-term survival after CCRT and HAIC followed by ALPPS for hepatocellular carcinoma with portal vein invasion: a case report

• Kim IJ
• Yoo SH
• Lee JI
• Lee KS
• Lee HW
• Lim JH

• KMID: 2528301
• DOI: http://doi.org/10.17998/jlc.2022.03.07

Abstract

There are various methods for treating advanced hepatocellular carcinoma with portal vein invasion, such as systemic chemotherapy, transarterial chemoembolization, transarterial radioembolization, and concurrent chemoradiotherapy. These methods have similar clinical efficacy but are designed with a palliative aim. Herein, we report a case that experienced complete remission through “associating liver partition and portal vein ligation for staged hepatectomy (ALPPS)” after concurrent chemoradiotherapy and hepatic artery infusion chemotherapy. In this patient, concurrent chemoradiotherapy and hepatic artery infusion chemotherapy induced substantial tumor shrinkage, and hypertrophy of the nontumor liver was sufficiently induced by portal vein ligation (stage 1 surgery) followed by curative resection (stage 2 surgery). Using this approach, long-term survival with no evidence of recurrence was achieved at 16 months. Therefore, the optimal use of ALPPS requires sufficient consideration in cases of significant hepatocellular carcinoma shrinkage for curative purposes.

Keyword

Carcinoma; hepatocellular; Portal vein; Hepatectomy; Concurrent chemoradiotherapy; Case reports

Figure

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  Figure 1 Dynamic liver computed tomography at the time of diagnosis. (A) Arterial phase, (B) portal phase, and (C) delayed phase image. (D) Intrahepatic metastasis in S6 (green arrow) is observed.

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  Figure 2 Liver magnetic resonance imaging at the time of diagnosis. (A) Arterial phase showed a 9 cm enhancing mass in the S8 liver, (B) portal phase showed S8 portal vein infiltration (blue arrow), and (C) delayed phase showed a mass adjacent to the middle hepatic vein (red arrow). (D) Intrahepatic metastasis in S6 (yellow arrow) is observed in the delayed phase.

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  Figure 3 Liver magnetic resonance imaging after concurrent chemoradiotherapy and sequential hepatic artery infusion chemotherapy. The size of the main mass decreased to 7 cm in the (A) arterial phase, (B) portal phase, and (C) delayed phase. (D) The size of the S6 independent lesion (yellow arrow) showed no change in the delayed phase. The main lesion is slightly reduced, but stable disease status overall, according to mRECIST criteria.

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  Figure 4 Comparison of computed tomography images before and after portal vein ligation of the right portal vein and S4 branch. (A) The size of the left liver before portal vein ligation. (B) Ascites occurred 1 month after ligation. (C) Increased size of the left liver 10 months after ligation.

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  Figure 5 Dynamic liver computed tomography 16 months after associated liver partition and portal vein ligation for staged hepatectomy. Complete remission was maintained as seen in the (A) arterial phase, (B) portal phase, and (C) delayed phase.

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  Figure 6 Tumor markers during the total follow-up period from the time of diagnosis. Both AFP and PIVKA-II decreased. AFP, alpha-fetoprotein; PIVKA-II, protein induced by vitamin K absence or antagonist-II; ALPPS, associating liver partition and portal vein ligation for staged hepatectomy; CCRT, concurrent chemoradiotherapy; IA-FP CTx, intra-arterial 5-fluorouracil and cisplatin chemotherapy.

Reference

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