Skip to main content

Advertisement

SpringerLink
Log in

Successful multimodality treatment for advanced hepatocellular carcinoma with tumor thrombosis of the main portal trunk: a case study

  • Case Report
  • Published:
Clinical Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

The overall survival of patients with advanced hepatocellular carcinoma with tumor thrombosis of the main trunk or bilobar branches of the portal vein is extremely poor. Moreover, there is no standard treatment established for the condition. Herein, we present the case of a 65-year-old man who were treated the patient with hepatic arterial infusion chemotherapy, radiation therapy for tumor thrombosis, portal vein stent placement, lenvatinib administration, and renal venous shunt embolization. A complete response was observed according to mRECIST and the patient has been alive for 14 months since treatment initiation with no tumor recurrence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Llovet JM, Bru C, Bruix J, et al. Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis. 1999;19:329–38.

    Article  CAS  Google Scholar 

  2. Forner A, Reig M, Bruix J, et al. Hepatocellular carcinoma. Lancet. 2018;391:1301–14.

    Article  Google Scholar 

  3. Ando E, Yamashita F, Tanaka M, et al. A novel chemotherapy for advanced hepatocellular carcinoma with tumor thrombosis of the main trunk of the portal vein. Cancer. 1997;79:1890–6.

    Article  CAS  Google Scholar 

  4. Rossi S, Di Stasi M, Buscarini E, et al. Percutaneous RF interstitial thermal ablation in the treatment of hepatic cancer. AJR Am J Roentgenol. 1996;167:759–68.

    Article  CAS  Google Scholar 

  5. Llovet JM, Real MI, Montana X, et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomized controlled trial. Lancet. 2002;18(359):1734–9.

    Article  Google Scholar 

  6. Jang BK, Chung WJ, Park KS, et al. The efficacy of hepatic arterial infusion therapy for advanced hepatocellular carcinoma according to extrahepatic collateral feeding vessels. Korean J Hepatol. 2005;11:359–70.

    PubMed  Google Scholar 

  7. Kim DY, Park W, Lim DH, et al. Three-dimensional conformal radiotherapy for portal vein thrombosis of hepatocellular carcinoma. Cancer. 2005;103:2419–26.

    Article  Google Scholar 

  8. Obi S, Yoshida H, Toune R, et al. Combination therapy of intraarterial 5-fluorouracil and systemic interferon-alpha for advanced hepatocellular carcinoma with portal venous invasion. Cancer. 2006;106:1990–7.

    Article  CAS  Google Scholar 

  9. Uka K, Aikata H, Takaki S, et al. Pretreatment predictor of response, time to progression, and survival to intraarterial 5-fluorouracil/interferon combination therapy in patients with advanced hepatocellular carcinoma. J Gastroenterol. 2007;42:845–53.

    Article  CAS  Google Scholar 

  10. Llovet JM, Ricci S, Mazzaferro V, et al. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med. 2008;359:378–90.

    Article  CAS  Google Scholar 

  11. Cheng AL, Kang YK, Chen Z, et al. Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: a phase III randomized, double-blind, placebo-controlled trial. Lancet Oncol. 2009;10:25–34.

    Article  CAS  Google Scholar 

  12. Kim HY, Kim JD, Bae SH, et al. A comparative study of high-dose hepatic arterial infusion chemotherapy and transarterial chemoembolization using doxorubicin for intractable, advanced hepatocellular carcinoma. Korean J Hepatol. 2010;16:355–61.

    Article  CAS  Google Scholar 

  13. Ueshima K, Kudo M, Takita M, et al. Hepatic arterial infusion chemotherapy using low-dose 5-fluorouracil and cisplatin for advanced hepatocellular carcinoma. Oncology. 2010;781:148–53.

    Article  Google Scholar 

  14. Takayasu K, Arii S, Kudo M, et al. Superselective transarterial chemoembolization for hepatocellular carcinoma. Validation of treatment algorithm proposed by Japanese guidelines. J Hepatol. 2012;56:886–92.

    Article  Google Scholar 

  15. Hasegawa K, Kokudo N, Makuuchi M, et al. Comparison of resection and ablation for hepatocellular carcinoma: a cohort study based on a Japanese nationwide survey. J Hepatol. 2013;58:724–9.

    Article  Google Scholar 

  16. Bruix J, Qin S, Merle P, et al. Regorafenib for patients with hepatocellular carcinoma who progressed on sorafenib treatment (RESORCE): a randomized, double-blind, placebo-controlled, phase 3 trial. Lancet. 2017;389:56–66.

    Article  CAS  Google Scholar 

  17. Kudo M, Finn RS, Qin S, et al. Lenvatinib versus sorafenib in first-line treatment of patients with unresectable hepatocellular carcinoma: a randomized phase 3 non-inferiority trial. Lancet. 2018;391:1163–73.

    Article  CAS  Google Scholar 

  18. Personeni N, Rimassa L, Pressiani T, et al. Cabozantinib for the treatment of hepatocellular carcinoma. Expert Rev Anticancer Ther. 2019;19:847–55.

    Article  CAS  Google Scholar 

  19. Zhu AX, Kang YK, Yen CJ, et al. Ramucirumab after sorafenib in patients with advanced hepatocellular carcinoma and increased alpha-fetoprotein concentrations (REACH-2): a randomized, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol. 2019;20:282–96.

    Article  CAS  Google Scholar 

  20. Fujii T, Takayasu K, Muramatsu Y, et al. Hepatocellular carcinoma with portal tumor thrombus: analysis of factors determining prognosis. Jpn J Clin Oncol. 1993;23:105–9.

    CAS  PubMed  Google Scholar 

  21. Matsui J, Yamamoto Y, Funahashi Y, et al. E7080, a novel inhibitor that targets multiple kinases, has potent antitumor activities against stem cell factor producing human small cell lung cancer H146, based on angiogenesis inhibition. Int J Cancer. 2008;122:664–71.

    Article  CAS  Google Scholar 

  22. Tohyama O, Maysui J, Kodama K, et al. Antitumor activity of lenvatinib (e7080): an angiogenesis inhibitor that targets multiple receptor tyrosine kinases in preclinical human thyroid cancer models. J Thyroid Res. 2014;2014: 638747.

    Article  Google Scholar 

  23. Yamamoto Y, Matsui J, Matsushima T, et al. Lenvatinib, an angiogenesis inhibitor targeting VEGFR/FGFR, shows broad antitumor activity in human tumor xenograft models associated with microvessel density and pericyte coverage. Vasc Cell. 2014;6:18.

    Article  Google Scholar 

  24. Hiraoka A, Kumada T, Kariyama K, et al. Therapeutic of lenvatinib for unresectable hepatocellular carcinoma in clinical practice: multicenter analysis. Hepatol Res. 2019;49:111–7.

    Article  CAS  Google Scholar 

  25. Ando E, Tanaka M, Yamashita F, et al. Hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma with portal vein tumor thrombosis: analysis of 48 cases. Cancer. 2002;95:588–95.

    Article  Google Scholar 

  26. Song DS, Song MJ, Bae SH, et al. A comparative study between sorafenib and hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma with portal vein tumor thrombosis. J Gastroenterol. 2015;50:445–54.

    Article  CAS  Google Scholar 

  27. Kawaoka T, Aikata H, Kobayashi T, et al. Comparison of hepatic arterial infusion chemotherapy between 5-fluorouracil-based continuous infusion chemotherapy and low-dose cisplatin monotherapy for advanced hepatocellular carcinoma. Hepatol Res. 2018;48:1118–30.

    Article  CAS  Google Scholar 

  28. Ikeda M, Shimizu S, Sato T, et al. Sorafenib plus hepatic arterial infusion chemotherapy with cisplatin versus sorafenib for advanced hepatocellular carcinoma: randomized phase II trial. Ann Oncol. 2016;27:2090–6.

    Article  CAS  Google Scholar 

  29. Toya R, Murakami R, Baba Y, et al. Conformal radiation therapy for portal vein tumor thrombosis of hepatocellular carcinoma. Radiother Oncol. 2007;84:266–71.

    Article  Google Scholar 

  30. Fujino H, Kimura T, Aikata H, et al. Role of 3-D conformal radiotherapy for major portal vein tumor thrombosis combined with hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma. Hepatol Res. 2015;45:607–17.

    Article  CAS  Google Scholar 

  31. Kodama K, Kawaoka T, Aikata H, et al. Comparison of outcome of hepatic arterial infusion chemotherapy combined with radiotherapy and sorafenib for advanced hepatocellular carcinoma patients with major portal vein tumor thrombosis. Oncology. 2018;94:215–22.

    Article  CAS  Google Scholar 

  32. Finn RS, Qin S, Ikeda M, et al. Atezolizumab plus bevacizumab in unresectable hepatocellular carcinoma. N Engl J Med. 2020;382:1894–905.

    Article  CAS  Google Scholar 

  33. Hasegewa T, Yamakado K, Takaki H, et al. Portal venous stent placement for malignant portal venous stenosis or occlusion. Cardinovasc Intervent Radiol. 2015;38:1515–22.

    Article  Google Scholar 

  34. Tsukamoto T, Hirohashi K, Kudo S, et al. Percutaneous transhepatic metallic stent placement for malignant portal vein stenosis. Hepatogastroenterology. 2003;50:453–5.

    PubMed  Google Scholar 

  35. Yamakado K, Nakatsuka A, Tanaka N, et al. Malignant portal venous obstruction treated by stent placement significant factors affecting patency. J Vasc Interv Radiol. 2001;12:1407–15.

    Article  CAS  Google Scholar 

  36. Takaki H, Yamakado K, Nakatsuka A, et al. Stent placement for portal venous stenosis following major abdominal surgery. Hepatogastroenterology. 2009;56:407–10.

    PubMed  Google Scholar 

  37. Luo JJ, Zhang ZH, Liu QX, et al. Endovascular brachytherapy combined with stent placement and transarterial chemoembolization for treatment of HCC with main portal vein tumor thrombus. Hepatol Int. 2016;10:185–95.

    Article  Google Scholar 

  38. Lu J, Guo JH, Zhu HD, et al. Safety and efficacy of irradiation stent placement for malignant portal vein thrombus combined with transarterial chemoembolization for hepatocellular carcinoma. J Vasc Interv Radiol. 2017;28:786–94.

    Article  Google Scholar 

  39. Ishikawa T, Kubota T, Abe H, et al. Percutaneous transhepatic portal vein stent placement can improve prognosis for hepatocellular carcinoma patients with portal vein tumor thrombosis. Hepatogastroenterology. 2014;61:413–6.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan

    Yumi Kosaka, Tomokazu Kawaoka, Yutaro Ogawa, Kei Amioka, Kensuke Naruto, Yuki Yoshikawa, Yuwa Ando, Yosuke Suehiro, Kenji Yamaoka, Yasutoshi Fujii, Shinsuke Uchikawa, Atsushi Ono, Masami Yamauchi, Michio Imamura & Hiroshi Aikata

  2. Diagnostic Radiology, Hiroshima University, Hiroshima, Japan

    Keigo Chosa & Kazuo Awai

  3. Therapeutic Radiology, Institute and Graduate School of Biomedical Science, Hiroshima University, Hiroshima, Japan

    Yasushi Nagata

  4. Research Center for Hepatology and Gastroenterology, Hiroshima University, Hiroshima, Japan

    Kazuaki Chayama

  5. Institute of Physical and Chemical Research (RIKEN) Center for Integrative Medical Sciences, Yokohama, Japan

    Kazuaki Chayama

  6. Collaborative Research Laboratory of Medical Innovation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan

    Kazuaki Chayama

Authors
  1. Yumi Kosaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tomokazu Kawaoka
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yutaro Ogawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kei Amioka
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kensuke Naruto
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yuki Yoshikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yuwa Ando
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yosuke Suehiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kenji Yamaoka
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yasutoshi Fujii
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Shinsuke Uchikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Atsushi Ono
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Masami Yamauchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Michio Imamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Keigo Chosa
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Kazuo Awai
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Yasushi Nagata
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Kazuaki Chayama
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Hiroshi Aikata
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hiroshi Aikata.

Ethics declarations

Conflict of interest

Kazuaki Chayama has received honoraria from Bristol-Myers Squibb, MSD K.K., AbbVie Inc., Gilead Sciences, Dainippon Sumitomo Pharma and Mitsubishi Tanabe and research funding from Dainippon Sumitomo Pharma, MSD K.K, AbbVie Inc, Eisai, Toray, Otsuka, Chugai, Takeda, Roche, Mitsubishi Tanabe and Bristol-Byers Squibb. Michio Imamura has received research funding from Bristol-Myers Squibb. Other authors declare no competing interests.

Human rights

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

Informed consent

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

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kosaka, Y., Kawaoka, T., Ogawa, Y. et al. Successful multimodality treatment for advanced hepatocellular carcinoma with tumor thrombosis of the main portal trunk: a case study. Clin J Gastroenterol 14, 1517–1524 (2021). https://doi.org/10.1007/s12328-021-01481-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12328-021-01481-9

Keywords

Search

Navigation