A Case of Hepatocellular Carcinoma (18 cm) with Portal Vein Tumor Thrombosis Successfully Treated by Multidisciplinary Therapy Including Preoperative Radiotherapy

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  • KATO Toru
    Departments of Surgery, National Defense Medical College
  • AOSASA Suefumi
    Departments of Surgery, National Defense Medical College
  • NORO Takuji
    Departments of Surgery, National Defense Medical College
  • OGATA Sho
    Laboratory Medicine, National Defense Medical College Hospital
  • UENO Hideki
    Departments of Surgery, National Defense Medical College
  • YAMAMOTO Junji
    Departments of Surgery, National Defense Medical College

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Other Title
  • 放射線治療を含む術前治療後に切除した門脈腫瘍栓合併肝細胞癌（18cm）の1例
  • 症例 放射線治療を含む術前治療後に切除した門脈腫瘍栓合併肝細胞癌(18cm)の1例
  • ショウレイ ホウシャセン チリョウ オ フクム ジュツゼン チリョウ ゴ ニ セツジョ シタ モンミャク シュヨウセン ガッペイ カン サイボウ ガン(18cm)ノ 1レイ

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Abstract

Prognosis of hepatocellular carcinoma (HCC) with macroscopic portal vein tumor thrombus (PVTT) is very poor. We report a case of giant HCC with PVTT successfully treated by perioperative multidisciplinary therapy including preoperative radiotherapy. A 59-year-old man complaining of body weight loss was admitted to our hospital. He was diagnosed with hepatitis B more than 20 years previously, but he had not received appropriate treatment. He was HBs-antigen positive and HCV-antibody negative. The ICG R15 was 5.3% and he was categorized into Child-Pugh Grade B. An abdominal computed tomography scan revealed a 18×10×13cm hypervascular tumor in the left hepatic lobe occupying more than 60% of the liver with PVTT-extending from left branch of the portal vein to the right anterior and posterior branches and the total occlusion of the left portal vein branch with tumor thrombus. After transcatheter arterial infusion chemotherapy (TAI) and transcatheter arterial chemoembolization (TACE) as the first live therapy, for the purpose of reduction of PVTT, preoperative intensity modulated radiation therapy (56Gy/8Fr) was performed. Although imaging studies conducted one month after the radiotherapy did not reveal shrinkage of the tumor but only decreased enhancement effect of the tumor thrombi, on the 46th days after the radiotherapy, extended left hepatectomy with removal of the tumor thrombi was performed. TACE was done for intrahepatic metastasis of the cancer remnant 5 months after the surgery. The patient has been alive with no recurrence 28 months after the surgery. This case suggests that some patients with advanced HCC having more than 10 cm in diameter with PVTT can achieve a long-term survival by multidisciplinary therapies.

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