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Hepatocellular carcinoma tumor thrombus entering the inferior vena cava treated with percutaneous RF ablation: a case report

  • Pietro Gatti
  • Antonio Giorgio
  • Emanuela Ciracì
  • Italia Roberto
  • Alessandro Anglani
  • Spano Sergio
  • Fernando Rizzello
  • Valentina Giorgio
  • Stefano SemeraroEmail author
Case Report
  • 23 Downloads

Abstract

Purpose

Hepatocellular carcinoma (HCC) is the most common form of liver cancer. In advanced cancer stages (metastatic disease and/or vascular invasion), the generally accepted standard of care is systemic therapy using sorafenib as first-line treatment and, recently, regorafenib and nivolumab as second-line treatment, but the quality of life and the prognosis of patients remain very poor. Our paper reports a case of US-guided radiofrequency ablation (RFA) of both intraparenchymal HCC and inferior vena cava tumor thrombus.

Methods

We treated a patient with HCC associated with tumor thrombus extending into vena cava after failure of sorafenib therapy using US-guided radiofrequency ablation (RFA).

Results

A good radiological and clinical response was observed in association with excellent tolerability. The patient has been followed up for 15 months from the ablation, is alive, and is in a good clinical condition without evidence of tumor recurrence.

Conclusion

This is the first case in which this minimally invasive percutaneous procedure has been successfully used to treat an HCC thrombus entering the vena cava.

Keywords

Hepatocellular carcinoma Sorafenib Locoregional therapy Tumor thrombus US-guided radiofrequency ablation 

Abbreviations

HCC

Hepatocellular carcinoma

BCLC

Barcelona clinic liver cancer

OS

Overall survival

TACE

Transarterial chemoembolization

HAIC

Hepatic arterial infusion chemotherapy

HIFU

High-intensity focused ultrasound

US

Ultrasound

MWA

Microwave ablation

RFA

Radiofrequency ablation

CPS

Child–Pugh score

PST

Performance status

RT

Radiotherapy

SIRT

Selective internal radiation therapy

LRT

Locoregional therapy

TT

Tumor thrombus

e-CT

Contrast-enhanced computerized tomography

IVC

Inferior vena cava

AFP

Alfa-fetoprotein

PEI

Percutaneous ethanol injection

DEB

Drug-eluting bead

CEUS

Contrast-enhanced ultrasound

INR

International normalised ratio

PLT

Platelet

FDA

Food and Drug Administration

EMA

European Medicines Agency

QOL

Quality of life

Notes

Funding

This study was not funded by anyone.

Compliance with ethical standards

Conflict of interest

All the authors (Pietro Gatti, Antonio Giorgio, Emanuela Ciracì, Italia Roberto, Alessandro Anglani, Sergio Spano, Fernando Rizzello, Valentina Giorgio, Stefano Semeraro) declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from the participant included in the study.

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Copyright information

© Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB) 2019

Authors and Affiliations

  • Pietro Gatti
    • 1
  • Antonio Giorgio
    • 2
  • Emanuela Ciracì
    • 1
  • Italia Roberto
    • 1
  • Alessandro Anglani
    • 3
  • Spano Sergio
    • 4
  • Fernando Rizzello
    • 5
  • Valentina Giorgio
    • 6
  • Stefano Semeraro
    • 1
    Email author
  1. 1.Internal Medicine DivisionOstuni HospitalOstuniItaly
  2. 2.Interventional Ultrasound UnitTortorella Clinical HospitalSalernoItaly
  3. 3.Radiodiagnostic UnitOstuni HospitalOstuniItaly
  4. 4.Interventional Radiology UnitPerrino HospitalBrindisiItaly
  5. 5.Anesthesiology and Reanimation UnitOstuni HospitalOstuniItaly
  6. 6.Pediatric Gastroenterology Unit, Policlinico GemelliSacred Heart UniversityRomeItaly

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