[Large hepatocellular carcinoma successfully treated with transarterial chemoembolization using cisplatin]

Area of Science:

• Hepatobiliary Medicine
• Interventional Radiology
• Oncology

Background:

• Hepatocellular carcinoma (HCC) poses a significant challenge, particularly in elderly patients with comorbidities.
• Protein induced by vitamin K deficiency and antagonist-II (PIVKA-II) is a sensitive tumor marker for HCC.
• Transarterial chemoembolization (TACE) is a standard treatment for unresectable HCC.

Observation:

• An 83-year-old male presented with a large hepatic tumor, elevated PIVKA-II levels (50792mAU/ml), and diagnosed HCC.
• Due to advanced age and cardiac history, the patient received cisplatin-based lipiodol transarterial chemoembolization (Lip-TACE).
• No adverse effects were noted during or after the Lip-TACE procedure.

Findings:

• Following the third Lip-TACE session, PIVKA-II levels normalized and remained within the normal range for 26 months.
• Abdominal CT demonstrated a reduction in HCC size with lipiodol accumulation, indicating a partial response (PR).
• The patient remained clinically well for three years post-initial Lip-TACE treatment.

Implications:

• Lip-TACE offers a safe and effective treatment option for elderly HCC patients, even with comorbidities.
• Sustained normalization of PIVKA-II levels can serve as an indicator of treatment efficacy and long-term disease control.
• This case highlights the potential of Lip-TACE for achieving durable responses in advanced hepatocellular carcinoma.