Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 14, 2016; 22(42): 9445-9450
Published online Nov 14, 2016. doi: 10.3748/wjg.v22.i42.9445
Complete response with sorafenib and transcatheter arterial chemoembolization in unresectable hepatocellular carcinoma
Michitoshi Takano, Takashi Kokudo, Yoshihiro Miyazaki, Yumiko Kageyama, Amane Takahashi, Katsumi Amikura, Hirohiko Sakamoto
Michitoshi Takano, Takashi Kokudo, Yoshihiro Miyazaki, Yumiko Kageyama, Amane Takahashi, Katsumi Amikura, Hirohiko Sakamoto, Division of gastroenterological surgery, Saitama Cancer Center, Kitaadachi-gun, Saitama 362-0806, Japan
Author contributions: Takano M wrote the original manuscript; all authors participated in drafting and editing the manuscript; all authors read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Saitama Cancer Center Institutional Review Board.
Informed consent statement: The patient has provided informed consent for the publication of this case report and accompanying images.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Michitoshi Takano, MD, Division of gastroenterological surgery, Saitama Cancer Center, 780 Komuro, Ina-machi, Kitaadachi-gun, Saitama 362-0806, Japan. michitaka1983@gmail.com
Telephone: +81-48-7221111 Fax: +81-48-7221129
Received: July 20, 2016
Peer-review started: July 22, 2016
First decision: July 21, 2016
Revised: August 11, 2016
Accepted: August 23, 2016
Article in press: August 23, 2016
Published online: November 14, 2016
Processing time: 115 Days and 7.8 Hours
Abstract

Patients with advanced hepatocellular carcinoma (HCC) showing portal vein tumor thrombosis (PVTT) have an extremely poor prognosis. According to treatment guidelines, the only option for HCC patients with PVTT is sorafenib chemotherapy. However, in Asia, various treatments have been attempted and possible prolongation of overall survival has been repeatedly reported. We herein report the first case of a patient with an initially unresectable advanced HCC with PVTT who underwent curative hepatectomy after sorafenib and transcatheter arterial chemoembolization (TACE) showing complete histological response. Two months after induction with sorafenib, a significant decrease in serum alpha-fetoprotein level was observed and computed tomography imaging showed a significant decrease in tumor size. Because of remaining PVTT, TACE and curative resection were performed. The combination of sorafenib and TACE may be an effective treatment for HCC patients with PVTT.

Keywords: Hepatocellular carcinoma; Sorafenib; Complete response; Portal vein tumor thrombosis; Transcatheter arterial chemoembolization

Core tip: Patients with advanced hepatocellular carcinoma (HCC) showing portal vein tumor thrombosis (PVTT) have an extremely poor prognosis. The only proposed treatment option for HCC patients with PVTT is sorafenib chemotherapy. However, in Asia, various treatments have been attempted and possible prolongation of overall survival has been repeatedly reported. Here we report the first case of a patient with an initially unresectable advanced HCC and PVTT who underwent curative hepatectomy after sorafenib and transcatheter arterial chemoembolization (TACE) showing complete histological response. The combination of sorafenib and TACE may be an effective treatment for HCC patients with PVTT.