Complete remission of advanced hepatocellular carcinoma following transient chemoembolization and portal vein ligation
Abstract Background Macroscopic diffuse-type hepatocellular carcinoma with concomitant major portal vein tumor thrombus (PVTT) and peritoneal dissemination indicates poor prognosis. Additionally, triple-positive tumor marker status is a predictor of poor outcome even after hepatectomy. Sorafenib is...
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| Format: | Article |
| Language: | English |
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Japan Surgical Society
2018-08-01
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| Series: | Surgical Case Reports |
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| Online Access: | http://link.springer.com/article/10.1186/s40792-018-0510-8 |
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| author | Yuki Koga Toru Beppu Katsunori Imai Kunitaka Kuramoto Tatsunori Miyata Yuki Kitano Shigeki Nakagawa Hirohisa Okabe Kazutoshi Okabe Yo-ichi Yamashita Akira Chikamoto Hideo Baba |
| author_facet | Yuki Koga Toru Beppu Katsunori Imai Kunitaka Kuramoto Tatsunori Miyata Yuki Kitano Shigeki Nakagawa Hirohisa Okabe Kazutoshi Okabe Yo-ichi Yamashita Akira Chikamoto Hideo Baba |
| author_sort | Yuki Koga |
| collection | DOAJ |
| description | Abstract Background Macroscopic diffuse-type hepatocellular carcinoma with concomitant major portal vein tumor thrombus (PVTT) and peritoneal dissemination indicates poor prognosis. Additionally, triple-positive tumor marker status is a predictor of poor outcome even after hepatectomy. Sorafenib is recommended in such patients, but it has limited therapeutic effectiveness. Case presentation A 54-year-old man was diagnosed with a liver abscess that was treated by puncture and drainage at a regional hospital. However, the diagnosis was subsequently changed to hepatocellular carcinoma with macroscopic portal vein tumor thrombus, based on the results obtained for the triple-positive tumor markers (alpha-fetoprotein, 45,928 ng/ml; protein induced by vitamin K absence or antagonist-II, 125,350 mAU/ml; and alpha-fetoprotein-L3, 38.3%). As the patient’s liver functional reserve was not adequate for curative resection, chemoembolization was performed with a hepatic arterial infusion of cisplatin (50 mg) and 5-FU (1000 mg), followed by mild embolization with cisplatin (50 mg) suspended in lipiodol (5 ml) and starch microspheres (300 mg) containing mitomycin C (4 mg). As the thrombus had progressed to the bifurcation of the right and left portal veins, the right vein was surgically ligated. Three peritoneal nodules could be identified and were removed. Three additional rounds of hepatic arterial chemotherapy/chemoembolization were performed after the initial surgery. At the 2-year evaluation, all tumor markers were observed to have normalized and diagnostic imaging showed complete remission. Conclusions Complete remission of hepatocellular carcinoma with macroscopic portal vein tumor thrombus and peritoneal dissemination was obtained with a treatment regimen that involved four rounds of hepatic arterial infusion chemotherapy and transient chemoembolization, portal vein ligation, and the removal of peritoneal dissemination. This regimen can be recommended for patients with advanced hemiliver lesions who cannot undergo curative resection. |
| format | Article |
| id | doaj-art-55dd56abe35d46649bb5ee7da8f4b91c |
| institution | DOAJ |
| issn | 2198-7793 |
| language | English |
| publishDate | 2018-08-01 |
| publisher | Japan Surgical Society |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj-art-55dd56abe35d46649bb5ee7da8f4b91c2025-08-20T02:53:15ZengJapan Surgical SocietySurgical Case Reports2198-77932018-08-01411610.1186/s40792-018-0510-8Complete remission of advanced hepatocellular carcinoma following transient chemoembolization and portal vein ligationYuki Koga0Toru Beppu1Katsunori Imai2Kunitaka Kuramoto3Tatsunori Miyata4Yuki Kitano5Shigeki Nakagawa6Hirohisa Okabe7Kazutoshi Okabe8Yo-ichi Yamashita9Akira Chikamoto10Hideo Baba11Department of Surgery, Yamaga City Medical CenterDepartment of Surgery, Yamaga City Medical CenterDepartment of Gastroenterological Surgery, Graduate School of Life Sciences Kumamoto UniversityDepartment of Surgery, Yamaga City Medical CenterDepartment of Gastroenterological Surgery, Graduate School of Life Sciences Kumamoto UniversityDepartment of Gastroenterological Surgery, Graduate School of Life Sciences Kumamoto UniversityDepartment of Gastroenterological Surgery, Graduate School of Life Sciences Kumamoto UniversityDepartment of Gastroenterological Surgery, Graduate School of Life Sciences Kumamoto UniversityDepartment of Gastroenterological Surgery, Graduate School of Life Sciences Kumamoto UniversityDepartment of Gastroenterological Surgery, Graduate School of Life Sciences Kumamoto UniversityDepartment of Gastroenterological Surgery, Graduate School of Life Sciences Kumamoto UniversityDepartment of Gastroenterological Surgery, Graduate School of Life Sciences Kumamoto UniversityAbstract Background Macroscopic diffuse-type hepatocellular carcinoma with concomitant major portal vein tumor thrombus (PVTT) and peritoneal dissemination indicates poor prognosis. Additionally, triple-positive tumor marker status is a predictor of poor outcome even after hepatectomy. Sorafenib is recommended in such patients, but it has limited therapeutic effectiveness. Case presentation A 54-year-old man was diagnosed with a liver abscess that was treated by puncture and drainage at a regional hospital. However, the diagnosis was subsequently changed to hepatocellular carcinoma with macroscopic portal vein tumor thrombus, based on the results obtained for the triple-positive tumor markers (alpha-fetoprotein, 45,928 ng/ml; protein induced by vitamin K absence or antagonist-II, 125,350 mAU/ml; and alpha-fetoprotein-L3, 38.3%). As the patient’s liver functional reserve was not adequate for curative resection, chemoembolization was performed with a hepatic arterial infusion of cisplatin (50 mg) and 5-FU (1000 mg), followed by mild embolization with cisplatin (50 mg) suspended in lipiodol (5 ml) and starch microspheres (300 mg) containing mitomycin C (4 mg). As the thrombus had progressed to the bifurcation of the right and left portal veins, the right vein was surgically ligated. Three peritoneal nodules could be identified and were removed. Three additional rounds of hepatic arterial chemotherapy/chemoembolization were performed after the initial surgery. At the 2-year evaluation, all tumor markers were observed to have normalized and diagnostic imaging showed complete remission. Conclusions Complete remission of hepatocellular carcinoma with macroscopic portal vein tumor thrombus and peritoneal dissemination was obtained with a treatment regimen that involved four rounds of hepatic arterial infusion chemotherapy and transient chemoembolization, portal vein ligation, and the removal of peritoneal dissemination. This regimen can be recommended for patients with advanced hemiliver lesions who cannot undergo curative resection.http://link.springer.com/article/10.1186/s40792-018-0510-8Hepatocellular carcinomaPortal vein tumor thrombusPeritoneal disseminationComplete remissionChemoembolizationPortal vein ligation |
| spellingShingle | Yuki Koga Toru Beppu Katsunori Imai Kunitaka Kuramoto Tatsunori Miyata Yuki Kitano Shigeki Nakagawa Hirohisa Okabe Kazutoshi Okabe Yo-ichi Yamashita Akira Chikamoto Hideo Baba Complete remission of advanced hepatocellular carcinoma following transient chemoembolization and portal vein ligation Surgical Case Reports Hepatocellular carcinoma Portal vein tumor thrombus Peritoneal dissemination Complete remission Chemoembolization Portal vein ligation |
| title | Complete remission of advanced hepatocellular carcinoma following transient chemoembolization and portal vein ligation |
| title_full | Complete remission of advanced hepatocellular carcinoma following transient chemoembolization and portal vein ligation |
| title_fullStr | Complete remission of advanced hepatocellular carcinoma following transient chemoembolization and portal vein ligation |
| title_full_unstemmed | Complete remission of advanced hepatocellular carcinoma following transient chemoembolization and portal vein ligation |
| title_short | Complete remission of advanced hepatocellular carcinoma following transient chemoembolization and portal vein ligation |
| title_sort | complete remission of advanced hepatocellular carcinoma following transient chemoembolization and portal vein ligation |
| topic | Hepatocellular carcinoma Portal vein tumor thrombus Peritoneal dissemination Complete remission Chemoembolization Portal vein ligation |
| url | http://link.springer.com/article/10.1186/s40792-018-0510-8 |
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