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A case of complete remission of advanced hepatocellular carcinoma with type III portal vein tumor thrombosis treated using transarterial chemoembolization with microspheres and radiation therapy

Abstract

Portal vein tumor thrombosis (PVTT) is an extremely locally advanced form of hepatocellular carcinoma. The natural median survival time of patients with hepatocellular carcinoma with PVTT is 2.7 to 4.0 months. A 63-year-old woman visited our clinic complaining of abdominal distention and appetite loss, which she had had for 3 weeks prior to admission. A contrast-enhanced computed tomography scan showed double hepatocellular carcinomas with Type III PVTT and massive ascites caused by arterio-portal shunts within the PVTT. The ascites could not be treated by concentrated ascites reinfusion therapy or diuretics. Transarterial embolization using microspheres followed by radiation therapy against PVTT and five courses of transarterial chemoembolization using microspheres and cisplatin led to the maintaining of complete remission of both ascites and tumors for over 12 months after treatment. Fluoroglucose accumulation of PVTT showed 11.2 as a maximum standard uptake value on positron emission tomography before treatment. No fluoroglucose accumulation within PVTT was observed for over 12 months following treatment. Transarterial chemoembolization using microspheres followed by radiation therapy against Type III PVTT may result in drastic anti-cancer effects and improvement of both serum albumin and intractable ascites after treatment of arterio-portal shunts within the PVTT causing portal hypertension.

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Abbreviations

HCC:

Hepatocellular carcinoma

PVTT:

Portal vein tumor thrombosis

CT:

Computed tomography scan

PIVKAII:

Protein induced by vitamin K absence or antagonist-II

AP shunt:

Arterio-portal shunt

CART:

Concentrated ascites reinfusion therapy

EOB-MRI:

Gadoxetic acid-enhanced magnetic resonance imaging

FDG-PET:

Fluoroglucose positron emission tomography

TACE:

Transarterial chemoembolization

TAE:

Transarterial embolization

TAI:

Transarterial injection chemotherapy

BCLC:

Barcelona-clinic liver cancer

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Correspondence to Daizo Fukushima.

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Daizo Fukushima,Shigeki Imai, Noriyuki Nishino, Kohichi Hamada, Yasunori Horikawa, Yoshiki Shiwa, Shinya Nishida, Ryota Koyanagi, Hitoshi Wada, Hideo Sakuma declare that they have no conflict of interest.

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All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Informed consent was obtained from all patients for being included in the study.

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Fukushima, D., Imai, S., Nishino, N. et al. A case of complete remission of advanced hepatocellular carcinoma with type III portal vein tumor thrombosis treated using transarterial chemoembolization with microspheres and radiation therapy. Clin J Gastroenterol 13, 847–854 (2020). https://doi.org/10.1007/s12328-020-01124-5

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Keywords

  • Hepatocellular carcinoma
  • Portal vein tumor thrombosis
  • Arterio-portal shunt
  • Transarterial chemoembolization
  • Radiation therapy