Liang LC, Huang WS, Guo ZX, You HJ, Guo YJ, Cai MY, Lin LT, Wang GY, Zhu KS. Liver transplantation following two conversions in a patient with huge hepatocellular carcinoma and portal vein invasion: A case report. World J Gastroenterol 2024; 30(36): 4071-4077 [PMID: 39351247 DOI: 10.3748/wjg.v30.i36.4071]
Corresponding Author of This Article
Kang-Shun Zhu, MD, PhD, Director, Doctor, Professor, Department of Minimally Invasive Interventional Radiology, The Second Affiliated Hospital of Guangzhou Medical University, No. 250 East Changgang Road, Guangzhou 510260, Guangdong Province, China. zhksh010@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
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/
Li-Cong Liang, Wen-Sou Huang, Zhao-Xiong Guo, Yong-Jian Guo, Ming-Yue Cai, Li-Teng Lin, Kang-Shun Zhu, Department of Minimally Invasive Interventional Radiology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, Guangdong Province, China
Hong-Ji You, Department of Nuclear Medicine, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, Guangdong Province, China
Guo-Ying Wang, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, Guangdong Province, China
Author contributions: Zhu KS guided the treatment plan; Huang WS, Guo YJ, Cai MY and Wang GY performed the interventional procedures and transplant surgery respectively; Guo ZX and You HJ collected and edited figures; Liang LC, Lin LT and Zhu KS analyzed the data and wrote the manuscript; all authors have read and approved the final manuscript.
Informed consent statement: Informed Written consent was obtained from the patient. This case was approved by the Institutional Review Board of the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China (No. 2024-hg-ks-04).
Conflict-of-interest statement: All the authors have no relevant conflicts of interest to declare for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kang-Shun Zhu, MD, PhD, Director, Doctor, Professor, Department of Minimally Invasive Interventional Radiology, The Second Affiliated Hospital of Guangzhou Medical University, No. 250 East Changgang Road, Guangzhou 510260, Guangdong Province, China. zhksh010@163.com
Received: March 2, 2024 Revised: August 23, 2024 Accepted: September 3, 2024 Published online: September 28, 2024 Processing time: 201 Days and 18.8 Hours
Abstract
BACKGROUND
Surgical resection and liver transplantation (LT) are the most effective curative options for hepatocellular carcinoma (HCC). However, few patients with huge HCC (> 10 cm in diameter), especially those with portal vein tumor thrombus (PVTT), can receive these treatments. Selective internal radiation therapy (SIRT) can be used as a conversion therapy for them because it has the dual benefit of shrinking tumors and increasing residual hepatic volume. However, in patients with huge HCC, high lung absorbed dose often prevents them from receiving SIRT.
CASE SUMMARY
A 35-year-old man was admitted because of emaciation and pain in the hepatic region for about 1 month. The computed tomography scan showed a 20.2 cm × 19.8 cm tumor located in the right lobe–left medial lobes with right portal vein and right hepatic vein invasion. After the pathological type of HCC was confirmed by biopsy, two conversions were presented. The first one was drug-eluting bead transarterial chemoembolization plus hepatic arterial infusion chemotherapy and lenvatinib and sintilimab, converted to SIRT, and the second one was sequential SIRT with continued systemic treatment. The tumor size significantly decreased from 20.2 cm × 19.8 cm to 16.2 cm × 13.8 cm, then sequentially to 7.8 cm × 6.8 cm. In the meantime, the ratio of spared volume to total liver volume increased gradually from 34.4% to 55.7%, then to 62.9%. Furthermore, there was visualization of the portal vein, indicating regression of the tumor thrombus. Finally, owing to the new tumor in the left lateral lobe, the patient underwent LT instead of resection without major complications.
CONCLUSION
Patients with inoperable huge HCC with PVTT could be converted to SIRT first and accept surgery sequentially.
Core Tip: We report a patient with > 20 cm hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT) who successfully received liver transplantation (LT) after two conversions. He was first converted to selective internal radiation therapy (SIRT) eligibility with transarterial chemoembolization and infusion chemotherapy combined with systemic therapy and then converted to LT with SIRT and continued systemic therapy. This is significant because few patients with huge (> 10 cm in diameter) HCC and PVTT can receive curative treatments or curative treatments after one conversion.
