Hepatocellular carcinoma tumor thrombus entering the inferior vena cava treated with percutaneous RF ablation: a case report
- 23 Downloads
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.
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).
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.
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.
KeywordsHepatocellular carcinoma Sorafenib Locoregional therapy Tumor thrombus US-guided radiofrequency ablation
Barcelona clinic liver cancer
Hepatic arterial infusion chemotherapy
High-intensity focused ultrasound
Selective internal radiation therapy
Contrast-enhanced computerized tomography
Inferior vena cava
Percutaneous ethanol injection
International normalised ratio
Food and Drug Administration
European Medicines Agency
Quality of life
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.
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 was obtained from the participant included in the study.
- 3.European Association for the Study of the Liver (2018) EASL clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 69:182–236 https://doi.org/10.1016/j.jhep.2018.03.019
- 5.Kudo M, Matsui O, Izumi N, Iijima H, Kadoya M, Imai Y et al; Liver Cancer Study Group of Japan (2014) JSH consensus-based clinical practice guideline for the management of hepatocellular carcinoma: 2014 update by the Liver Cancer Study Group of Japan. Liver Cancer 3:458–468. https://doi.org/ https://doi.org/10.1159/000343875
- 9.Giorgio A, Di Sarno A, de Stefano G, Farella N, Scognamiglio U, de Stefano M et al (2009) Hepatocellular carcinoma with cirrhosis: are patients with neoplastic main portal vein invasion eligible for percutaneous radiofrequency ablation of both the nodule and the portal venous tumor thrombus? Am J Roentgenol 193(4):948–954. https://doi.org/10.2214/AJR.08.2087 CrossRefGoogle Scholar
- 10.Giorgio A, Calisti G, Montesarchio L, Scognamiglio U, Matteucci P, Coppola C et al (2014) Hepatocellular carcinoma invading portal venous system in cirrhosis: long-term results of percutaneous radiofrequency ablation of both the nodule and portal vein tumor thrombus. A case control study. Anticancer Res 34:6785–6790Google Scholar
- 11.Florman S, Weaver M, Primeaux P, Killackey M, Sierra R, Gomez S et al (2009) Aggressive resection of hepatocellular carcinoma with right atrial involvement. Am Surg 75:1104–1108Google Scholar
- 13.Le Treut YP, Hardwigsen J, Ananian P, Saïsse J, Grégoire E, Richa H et al (2006) Resection of hepatocellular carcinoma with tumor thrombus in the major vasculature. A European case–control series. J Gastrointest Surg 10:855–862Google Scholar
- 16.Saynak M, Ozen A, Kocak Z, Cosar-Alas R, Uzal C (2007) Sudden death: a case report of hepatocellular carcinoma with tumor thrombus extending into the right atrium. J BUON 12:556Google Scholar
- 18.Cheng A-L, Kang Y-K, Chen Z, Tsao C-J, Qin S, Kim JS et al (2009) Efficacy and safety of sorafenib in patients in the Asia–Pacific region with advanced hepatocellular carcinoma: a phase III randomised, double-blind, placebo-controlled trial. Lancet Oncol 10:25–34. https://doi.org/10.1016/s1470-2045(08)70285-7 CrossRefGoogle Scholar
- 19.Cheng A-L, Guan Z, Chen Z, Tsao C-J, Qin S, Kim JS et al (2012) Efficacy and safety of sorafenib in patients with advanced hepatocellular carcinoma according to baseline status: Subset analyses of the phase III Sorafenib Asia–Pacific trial. Eur J Cancer 48:1452–1465. https://doi.org/10.1016/j.ejca.2011.12.006 CrossRefGoogle Scholar
- 20.Bruix J, Qin S, Merle P, Granito A, Huang YH, Bodoky G, Pracht M et al (2017) Regorafenib for patients with hepatocellular carcinoma who progressed on sorafenib treatment (RESORCE): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 389:56–66. https://doi.org/10.1016/S0140-6736(16)32453-9 CrossRefGoogle Scholar
- 21.El-Khoueiry AB, Sangro B, Yau T, Crocenzi TS, Kudo M, Hsu C, Kim TY et al (2017) Nivolumab in patients with advanced hepatocellular carcinoma (CheckMate 040): an open-label, non-comparative, phase 1/2 dose escalation and expansion trial. Lancet 389:2492–2502. https://doi.org/10.1016/S0140-6736(17)31046-2 CrossRefGoogle Scholar
- 22.Kim G-A, Shim JH, Yoon SM, Jung J, Kim JH, Ryu M-H et al (2015) Comparison of chemoembolization with and without radiation therapy and sorafenib for advanced hepatocellular carcinoma with portal vein tumor thrombosis: a propensity score analysis. J Vasc Interv Radiol 26:320–329. https://doi.org/10.1016/j.jvir.2014.10.019 CrossRefGoogle Scholar
- 23.Song DS, Song MJ, Bae SH, Chung WJ, Jang JY, Kim YS et al (2015) A comparative study between sorafenib and hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma with portalvein tumor thrombosis. J Gastroenterol 50:445–454. https://doi.org/10.1007/s00535-014-0978 CrossRefGoogle Scholar
- 25.Vilgrain V, Abdel-Rehim M, Sibert A, Ronot M, Lebtahi R, Castéra Let al; SARAH Trial Group (2014) Radioembolisation with yttrium-90 microspheres versus sorafenib for treatment of advanced hepatocellular carcinoma (SARAH): study protocol for a randomised controlled trial. Trials 15:474. https://doi.org/10.1186/1745-6215-15-474
- 26.(2017) SARAH: a randomised controlled trial comparing efficacy and safety of selective internal radiation therapy (with yttrium-90 microspheres) and sorafenib in patients with locally advanced hepatocellular carcinoma (GS012). In: The international liver congress 2017Google Scholar
- 27.Chow PKH, Gandhi M, Tan SB, Khin MW, Khasbazar A, Ong J et al; Asia–Pacific Hepatocellular Carcinoma Trials Group (2018) SIRveNIB: selective internal radiation therapy versus sorafenib in Asia–Pacific patients with hepatocellular carcinoma. J Clin Oncol 36:1913–1921. https://doi.org/10.1200/JCO.2017.76.0892
- 28.Poggi G, Gatti C, Teragni C, Delmonte A, Bernardo G (2004) Radiofrequency ablation combined with percutaneous ethanol injection in the treatment of hepatocellular carcinoma and portal vein neoplastic thrombosis. Anticancer Res 24:2419–2421Google Scholar
- 29.Hirooka M, Koizumi Y, Kisaka Y, Abe M, Murakami H, Matsuura B et al (2010) Mass reduction by radiofrequency ablation before hepatic arterial infusion chemotherapy improved prognosis for patients with huge hepatocellular carcinoma and portal vein thrombus. Am J Roentgenol 194:W221–W226. https://doi.org/10.2214/AJR.09.2852 CrossRefGoogle Scholar