Effective hepatic artery chemoembolization for advanced hepatocellular carcinoma with multiple tumor thrombi and pulmonary metastases: A case report

Huang,De‑Jia; Li,Yan‑Hao; Luo,Yao‑Chang; Huang,Jun‑Zhen; He,Hai‑Yuan

doi:10.3892/ol.2016.4846

Effective hepatic artery chemoembolization for advanced hepatocellular carcinoma with multiple tumor thrombi and pulmonary metastases: A case report

Authors:
- De‑Jia Huang
- Yan‑Hao Li
- Yao‑Chang Luo
- Jun‑Zhen Huang
- Hai‑Yuan He
View Affiliations

Affiliations: Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China, Department of Interventional Radiology, The First Affiliated Hospital of Guangxi Traditional Chinese Medical University, Nanning, Guangxi 530021, P.R. China
Published online on: July 12, 2016 https://doi.org/10.3892/ol.2016.4846
Pages: 2103-2106

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Advanced hepatocellular carcinoma (HCC) with tumor thrombi invading the portal vein and extending into the right atrium (RA) through the hepatic vein is regarded as a terminal‑stage condition. Intracardiac tumor thrombus and treatment via liver resection has been reported in the current literature, but results from this therapeutic approach remain unsatisfactory. The present study describes a rare case of HCC with metastatic portal vein, middle hepatic vein, inferior vena cava (IVC) and RA tumor thrombi, and pulmonary metastases. A 29‑year‑old woman was admitted to The First Affiliated Hospital of Guangxi Traditional Chinese Medical University (Nanning, China) subsequent to experiencing right upper quadrant abdominal pain. Following diagnosis, based on computed tomography analysis and laboratory data, the patient underwent an initial transcatheter arterial chemoembolization (TACE) treatment using fluorouracil (5‑FU), pirarubicin, mitomycin C, Lipiodol and sodium alginate microball (KMG). At 1 month post‑treatment, serum α‑fetoprotein levels remained at >1,000 ng/ml. Subsequently, the patient underwent a second TACE treatment. At 1 month after the second treatment, the abdominal pain had been alleviated and the serum α‑fetoprotein levels were reduced to <20 ng/ml. Imaging analysis indicated a marked reduction in tumor burden in the liver and the hepatic vein and IVC tumor thrombi. Furthermore, the portal vein and RA tumor thrombi, and the pulmonary metastases had disappeared. At 40 months after the second TACE therapy, the patient remains alive without any signs of recurrence. The present case demonstrates that the administration of TACE, using 5‑FU, pirarubicin, mitomycin C, Lipiodol and KMG, functions as an effective treatment in cases of unresectable advanced HCC presenting with pulmonary metastases and extensive tumor thrombi in the IVC, the RA and one branch of the portal vein.

View Figures

View References

1	Siegel R, Ma J, Zou Z and Jemal A: Cancer statistics, 2014. CA Cancer J Clin. 64:9–29. 2014. View Article : Google Scholar : PubMed/NCBI
2	Llovet JM, Fuster J and Bruix J: Prognosis of hepatocellular carcinoma. Hepatogastroenterology. 49:7–11. 2002.PubMed/NCBI
3	Tan CK, Law NM, Ng HS and Machin D: Simple clinical prognostic model for hepatocellular carcinoma in developing countries and its validation. J Clin Oncol. 21:2294–2298. 2003. View Article : Google Scholar : PubMed/NCBI
4	Llovet JM and Bruix J: Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival. Hepatology. 37:429–442. 2003. View Article : Google Scholar : PubMed/NCBI
5	Lencioni R, Chen XP, Dagher L and Venook AP: Treatment of intermediate/advanced hepatocellular carcinoma in the clinic: How can outcomes be improved? Oncologist. 15(Suppl 4): 42–52. 2010. View Article : Google Scholar : PubMed/NCBI
6	Kawano Y, Sasaki A, Kai S, Endo Y, Iwaki K, Uchida H, Shibata K, Ohta M and Kitano S: Short- and long-term outcomes after hepatic resection for hepatocellular carcinoma with concomitant esophageal varices in patients with cirrhosis. Ann Surg Oncol. 15:1670–1676. 2008. View Article : Google Scholar : PubMed/NCBI
7	Saab S, Yeganeh M, Nguyen K, Durazo F, Han S, Yersiz H, Farmer DG, Goldstein LI, Tong MJ and Busuttil RW: Recurrence of hepatocellular carcinoma and hepatitis B reinfection in hepatitis B surface antigen-positive patients after liver transplantation. Liver Transpl. 15:1525–1534. 2009. View Article : Google Scholar : PubMed/NCBI
8	Kato Y, Tanaka N, Kobayashi K, Ikeda T, Hattori N and Nonomura A: Growth of hepatocellular carcinoma into the right atrium. Report of five cases. Ann Intern Med. 99:472–474. 1983. View Article : Google Scholar : PubMed/NCBI
9	Kojiro M, Nakahara H, Sugihara S, Murakami T, Nakashima T and Kawasaki H: Hepatocellular carcinoma with intra-atrial tumor growth. A clinicopathologic study of 18 autopsy cases. Arch Pathol Lab Med. 108:989–992. 1984.PubMed/NCBI
10	Fujisaki M, Kurihara E, Kikuchi K, Nishikawa K and Uematsu Y: Hepatocellular carcinoma with tumor thrombus extending into the right atrium: Report of a successful resection with the use of cardiopulmonary bypass. Surgery. 109:214–219. 1991.PubMed/NCBI
11	Zeng ZC, Fan J, Tang ZY, Zhou J, Qin LX, Wang JH, Sun HC, Wang BL, Zhang JY, Jiang GL and Wang YQ: A comparison of treatment combinations with and without radiotherapy for hepatocellular carcinoma with portal vein and/or inferior vena cava tumor thrombus. Int J Radiat Oncol Biol Phys. 61:432–443. 2005. View Article : Google Scholar : PubMed/NCBI
12	Ohwada S, Tanahashi Y, Kawashima Y, Satoh Y, Nakamura S, Kobayashi I, Ohya T, Ishikawa S, Ohtaki A, Iino Y, et al: Surgery for tumor thrombi in the right atrium and inferior vena cava of patients with recurrent hepatocellular carcinoma. Hepatogastroenterology. 41:154–157. 1994.PubMed/NCBI
13	Kanematsu M, Imaeda T, Minowa H, Yamawaki Y, Mochizuki R, Goto H, Seki M, Doi H and Okumura S: Hepatocellular carcinoma with tumor thrombus in the inferior vena cava and right atrium. Abdom Imaging. 19:313–316. 1994. View Article : Google Scholar : PubMed/NCBI
14	Le Treut YP, Hardwigsen J, Ananian P, Saïsse J, Grégoire E, Richa H and Campan P: Resection of hepatocellular carcinoma with tumor thrombus in the major vasculature. A European case-control series. J Gastrointest Surg. 10:855–862. 2006. View Article : Google Scholar : PubMed/NCBI
15	Wang Y, Yuan L, Ge RL, Sun Y and Wei G: Survival benefit of surgical treatment for hepatocellular carcinoma with inferior vena cava/right atrium tumor thrombus: Results of a retrospective cohort study. Ann Surg Oncol. 20:914–922. 2013. View Article : Google Scholar : PubMed/NCBI
16	Chern MC, Chuang VP, Cheng T, Lin ZH and Lin YM: Transcatheter arterial chemoembolization for advanced hepatocellular carcinoma with inferior vena cava and right atrial tumors. Cardiovasc Intervent Radiol. 31:735–744. 2008. View Article : Google Scholar : PubMed/NCBI
17	Taura N, Hamasaki K, Nakao K, Ichikawa T, Nishimura D, Goto T, Fukuta M, Kawashimo H, Miyaaki H, Fujimoto M, et al: Aging of patients with hepatitis C virus-associated hepatocellular carcinoma: Long-term trends in Japan. Oncol Rep. 16:837–843. 2006.PubMed/NCBI
18	Fan HL, Chen TW, Hsieh CB, Jan HC, His SC, De-Chuan C, Chu CH and Yu JC: Liver transplantation is an alternative treatment of hepatocellular carcinoma beyond the Milan criteria. Am J Surg. 200:252–257. 2010. View Article : Google Scholar : PubMed/NCBI
19	Nam SW, Baek JT, Kang SB, Lee DS, Kim JI, Cho SH, Park SH, Han JY, Ahn BM, Kim JK and Chung KW: A case of the hepatocellular carcinoma during the pregnancy and metastasis to the left atrium. Korean J Hepatol. 11:381–385. 2005.PubMed/NCBI
20	Chong VH, Jamaludin AZ, Lim KS, Abdullah HM and Nair RT: Hepatocellular carcinoma with intravascular and right atrial extension. Indian J Gastroenterol. 27:2552008.PubMed/NCBI
21	Tanaka A, Morimoto T, Ozaki N, Ikai I, Yamamoto Y, Tsunekawa S, Kitai T and Yamaoka Y: Extension of surgical indication for advanced hepatocellular carcinoma: Is it possible to prolong life span or improve quality of life? Hepatogastroenterology. 43:1172–1181. 1996.PubMed/NCBI
22	Cheng HY, Wang XY, Zhao GL and Chen D: Imaging findings and transcatheter arterial chemoembolization of hepatic malignancy with right atrial embolus in 46 patients. World J Gastroenterol. 14:3563–3568. 2008. View Article : Google Scholar : PubMed/NCBI
23	Inoue Y, Hayashi M, Katsumata T, Shibayama Y and Tanigawa N: Hepatocellular carcinoma with right atrial tumor thrombus: Report of a case. Surg Today. 41:1122–1129. 2011. View Article : Google Scholar : PubMed/NCBI
24	Lin SM, Lin CJ, Lin CC, Hsu CW and Chen YC: Randomised controlled trial comparing percutaneous radiofrequency thermal ablation, percutaneous ethanol injection, and percutaneous acetic acid injection to treat hepatocellular carcinoma of 3 cm or less. Gut. 54:1151–1156. 2005. View Article : Google Scholar : PubMed/NCBI
25	Itoh S, Ikeda Y, Kawanaka H, Okuyama T, Kawasaki K, Eguchi D, Korenaga D and Takenaka K: Efficacy of surgical microwave therapy in patients with unresectable hepatocellular carcinoma. Ann Surg Oncol. 18:3650–3656. 2011. View Article : Google Scholar : PubMed/NCBI
26	Takayasu K, Arii S, Ikai I, et al: Prospective cohort study of transarterial chemoembolization for unresectable hepatocellular carcinoma in 8510 patients. Gastroenterology. 131:461–469. 2006. View Article : Google Scholar : PubMed/NCBI
27	Xue TC, Xie XY, Zhang L, Yin X, Zhang BH and Ren ZG: Transarterial chemoembolization for hepatocellular carcinoma with portal vein tumor thrombus: A meta-analysis. BMC Gastroenterol. 13:602013. View Article : Google Scholar : PubMed/NCBI
28	Nishikawa H, Osaki Y, Kita R and Kimura T: Hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma in Japan. Cancers (Basel). 4:165–183. 2012. View Article : Google Scholar : PubMed/NCBI
29	Miyazaki M, Suzuki H, Itoh H, et al: Portal vein infusion of cancer chemotherapeutic agent emulsified with Lipiodol in regenerating liver after partial hepatectomy in rats. Res Exp Med (Berl). 193:231–240. 1993. View Article : Google Scholar : PubMed/NCBI