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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

Clinical Journal of Gastroenterology volume 13, pages 847–854 (2020)Cite this article

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

References

  1. Llovet JM, Bustamante J, Castells A, et al. Natural history of untreated nonsurgical hepatocellular carcinoma: rationale for the design and evaluation of therapeutic trials. Hepatology. 1999;29:62–7.

    CAS  Article  Google Scholar 

  2. European Association For The Study Of The Liver; European Organisation For Research And Treatment Of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. European Association for the Study of the Liver; European Organisation for Research and Treatment of Cancer. J Hepatol. 2012;56:908–43.

    Article  Google Scholar 

  3. Lai EC, Lau WY. The continuing challenge of hepatic cancer in Asia. Surgeon. 2005;3:210–5.

    CAS  Article  Google Scholar 

  4. Poon RT, Fan ST, Tsang FH, et al. Locoregional therapies for hepatocellular carcinoma: a critical review from the surgeon’s perspective. Ann Surg. 2002;235:466–86.

    Article  Google Scholar 

  5. Minagawa M, Makuuchi M. Treatment of hepatocellular carcinoma accompanied by portal vein tumor thrombus. World J Gastroenterol. 2006;12:7561–7.

    CAS  Article  Google Scholar 

  6. Shi J, Lai EC, Li N, et al. A new classification for hepatocellular carcinoma with portal vein tumor thrombus. J Hepatobil Pancreat Sci. 2011;18:74–80.

    Article  Google Scholar 

  7. Bruix J, Raoul JL, Sherman M, et al. Efficacy and safety of sorafenib in patients with advanced hepatocellular carcinoma: subanalyses of a phase III trial. J Hepatol. 2012;57:821–9.

    CAS  Article  Google Scholar 

  8. Wang JC, Xia AL, Xu Y, et al. Comprehensive treatments for hepatocellular carcinoma with portal vein tumor thrombosis. J Cell Physiol. 2019;234:1062–70.

    CAS  Article  Google Scholar 

  9. Wang K, Guo WX, Chen MS, et al. Multimodality treatment for hepatocellular carcinoma with portal vein tumor thrombus: a large-scale, multicenter, propensity mathching score analysis. Medicine (Baltimore). 2016. https://doi.org/10.1097/MD.0000000000003015.

    Article  Google Scholar 

  10. Niu ZJ, Ma YL, Kang P, et al. Transarterial chemoembolization compared with conservative treatment for advanced hepatocellular carcinoma with portal vein tumor thrombus: using a new classification. Med Oncol. 2012;29:2992–7.

    CAS  Article  Google Scholar 

  11. Lee IJ, Seong J. The optimal selection of radiotherapy treatment for hepatocellular carcinoma. Gut Liver. 2012;6:139–48.

    CAS  Article  Google Scholar 

  12. Im JH, Yoon SM, Park HC, et al. Radiotherapeutic strategies for hepatocellular carcinoma with portal vein tumour thrombosis in a hepatitis B endemic area. Liver Int. 2017;37:90–100.

    CAS  Article  Google Scholar 

  13. Huang MS, Lin Q, Jiang ZB, et al. Comparison of long-term effects between intra-arterially delivered ethanol and Gelfoam for the treatment of severe arterioportal shunt in patients with hepatocellular carcinoma. World J Gastroenterol. 2004;10:825–9.

    CAS  Article  Google Scholar 

  14. Imai Y, Hirooka M, Koizumi Y, et al. Histological assessment of the efficacy of drug-eluting beads in portal tumor thrombosis of hepatocellular carcinoma. Radiol Case Rep. 2016;12:179–84.

    Article  Google Scholar 

  15. Song JE, Kim DY. Conventional vs drug-eluting beads transarterial chemoembolization for hepatocellular carcinoma. World J Hepatol. 2017;28:808–14.

    Article  Google Scholar 

  16. Xiao YD, Ma C, Zhang ZS, et al. Safety and efficacy assessment of transarterial chemoembolization using drug-eluting beads in patients with hepatocellular carcinoma and arterioportal shunt: a single-center experience. Cancer Manag Res. 2019;11:1551–7.

    CAS  Article  Google Scholar 

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Authors and Affiliations

  1. Department of Gastroenterology, Southern Tohoku General Hospital, 7-115 Yatsuyamada, Koriyama, Fukushima, 963-8563, Japan

    Daizo Fukushima, Noriyuki Nishino, Yoshinori Horikawa, Yoshiki Shiwa & Shinya Nishida

  2. Department of Radiology, Southern Tohoku Research Institute for Neuroscience, 7-115 Yatsuyamada, Koriyama, 963-8563, Japan

    Shigeki Imai

  3. Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, 960-1295, Japan

    Kohichi Hamada & Ryota Koyanagi

  4. Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima, 963-8052, Japan

    Hitoshi Wada

  5. Department of Pathology, Southern Tohoku Research Institute for Neuroscience, 7-115 Yatsuyamada, Koriyama, 963-8563, Japan

    Hideo Sakuma

Authors
  1. Daizo Fukushima
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  2. Shigeki Imai
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  3. Noriyuki Nishino
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  4. Kohichi Hamada
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  5. Yoshinori Horikawa
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  6. Yoshiki Shiwa
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  7. Shinya Nishida
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  8. Ryota Koyanagi
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  9. Hitoshi Wada
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  10. Hideo Sakuma
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Correspondence to Daizo Fukushima.

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Conflict of interest

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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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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  • DOI: https://doi.org/10.1007/s12328-020-01124-5

Keywords

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