[Combined Modality Therapy for Giant Hepatocellular Carcinoma and Multiple Lung Metastases-A Case Study]

Here, we present the case of a 47-year-old woman with liver masses having distinct borders, which were located approximately 13 cm from the left hepatic lobe S4, as visualized on a CT scan. Hepatocellular carcinoma(HCC)was suspected from these contrast findings. Additionally, we found nodules in the right upper lobe of the lung and in the left apex. Although test results for hepatitis B and C viruses were negative, the α-fetoprotein(AFP)level was elevated. The tumor was diagnosed as a HCC with suspected multiple lung metastases. Thereafter, a resection was performed for the HCC. However, multiple recurrences were observed. Arterial embolization using transcatheterization was performed thrice 5 months after resection. Further, 6 months after resection, lenvatinib therapy was initiated as the pulmonary nodule increased in size. One year after the operation, a recurrent neoplastic lesion in the liver was detected on the contrast-enhanced MRI. Since the earlier treatment with transcatheter arterial embolization proved to be minimally effective, we opted for arterial injection chemotherapy with cisplatin plus 5-FU for approximately 3 months. The contrast-enhanced CT revealed that the lesion became a low absorption lesion in the liver outside the central area, and the AFP also decreased rapidly. Therefore, the therapy was considered effective. As a side effect of arterial injection chemotherapy, the patient developed a duodenal ulcer. However, after treating the ulcer, a pulmonary metastasectomy was performed and no obvious recurrence was noted. Typically, for treatment of extrahepatic metastases of HCC, drugs such as sorafenib or lenvatinib that have molecular targets are selected according to a treatment algorithm based on liver cancer practice guidelines. However, these drugs were not effective in this case, whereas arterial injection chemotherapy showed satisfactory therapeutic effect on the recurrences in the liver. Although there was a complication of duodenal ulcer, this case report highlights that combined modality therapy including arterial injection chemotherapy is successful in treating HCC.