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Complete Response in Metastatic Hepatocellular Carcinoma with Cardiac and Lung Involvement via Multimodality
Kun-Feng Tsai1,2, Jerry C H Tsai3, Ming-Feng Li4,5
1Gastroenterology and Hepatology Section, Department of Internal Medicine, An Nan Hospital, China Medical University, Tainan 709, Taiwan.
Insights
Advanced hepatocellular carcinoma (HCC) with major vessel involvement has a poor prognosis. This case shows successful multimodal treatment, including surgery, sorafenib, and immunotherapy, leading to a complete response.
Area of Science:
- Hepatobiliary Oncology
- Surgical Oncology
- Medical Oncology
Background:
- Advanced hepatocellular carcinoma (HCC) with major vascular and cardiac invasion historically presents a dismal prognosis.
- Limited effective therapeutic options exist for patients with advanced HCC involving the major vessels.
Observation:
- A 63-year-old male with metastatic HCC presented with tumor thrombi in the right atrium (RA) and inferior vena cava (IVC), alongside pulmonary metastases.
- The patient's condition involved extensive tumor burden with critical vascular and cardiac structures compromised.
Findings:
- Multimodal therapy, including surgical thrombectomy, systemic sorafenib, locoregional therapies, and immunotherapy, was employed.
- The patient achieved a complete response, maintaining remission for over 33 months post-treatment.
Implications:
- This case highlights the potential efficacy of an aggressive, multimodal treatment strategy for advanced HCC with major vascular involvement.
- Consideration of aggressive treatment is warranted for select patients who can tolerate combined therapeutic modalities.
Abstract:
Background: Until recently, advanced HCC patients with major vessel and cardiac involvement have had an extremely poor prognosis without satisfactory treatment. Case presentation: A 63-year-old Taiwanese male presented with metastatic HCC with RA and IVC thrombi, as well as pulmonary metastases that were successfully treated by multimodal management, encompassed by surgical thrombectomy, concurrent systemic sorafenib and locoregional therapies, and immunotherapy. The patient has achieved a complete response over the past 33 months. Conclusions: Through this case report, which shows a successful outcome via multimodal management, a more aggressive approach should be considered when a patient is expected to tolerate the risks and side effects of various treatments.
