Transplantation After Successful Downstaging by Multimodal Treatments of American Joint Committee on Cancer Stage IIIB Hepatocellular Carcinoma With Portal Vein Thrombi: A Case Report

• Published in: Transplantation proceedings Vol. 50; no. 9; pp. 2882 - 2884
• Main Authors: Jeng, K.-S., Huang, C.-C., Chung, C.-S., Lin, C.-K., Teng, C.-J., Shueng, P.-W., Chen, K.-H.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2018
• Subjects: Adult; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - therapy; Combined Modality Therapy - methods; Humans; Liver Neoplasms - pathology; Liver Neoplasms - therapy; Liver Transplantation - methods; Male; Middle Aged; Portal Vein - pathology; Thrombosis - pathology; Treatment Outcome; United States; United States
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2017.11.081

The effective treatment for hepatocellular carcinoma (HCC) with American Joint Committee on Cancer stage IIIB remains controversial and challenging because of the high recurrence rate after resection and low survival rate. The median survival of those with macroscopic portal vein tumor thrombus (PVTT) is short. We reported such a case which received liver transplantation (LT) after successful consecutive downstaging therapies. A 40-year-old man with alcohol related liver cirrhosis and repeated esophageal varices bleeding had HCC with tumor thrombi in right main portal vein and the second portal branch of segment VI (stage IIIB). The received percutaneous alcohol injection, radiofrequency ablation, 8 sessions of transcatheter hepatic arterial chemoembolization, radiotherapy, and target therapy with sorafenib. Computed tomography (CT) scan and magnetic resonance imaging after treatments showed no viable fragments in the tumor and revealed both the right main portal vein and V1 branch were patent. One month later, the patient received a deceased LT. The perioperative course was rather smooth. After discharge, the interval follow-up CT studies of the chest and liver and whole body bone scan showed no tumor recurrence or metastasis up to 20 months postoperation. •The treatment of HCC portal vein tumor thrombus remains challenging.•Multimodal downstaging to meet the Milan criteria is successful.•The patient in the present case had received liver transplantation and presented tumor-free up to 20 months posttransplant.