A case of complete remission of advanced hepatocellular carcinoma with type III portal vein tumor thrombosis treated usi

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A case of complete remission of advanced hepatocellular carcinoma with type III portal vein tumor thrombosis treated using transarterial chemoembolization with microspheres and radiation therapy Daizo Fukushima1 · Shigeki Imai2 · Noriyuki Nishino1 · Kohichi Hamada3 · Yoshinori Horikawa1 · Yoshiki Shiwa1 · Shinya Nishida1 · Ryota Koyanagi3 · Hitoshi Wada4 · Hideo Sakuma5 Received: 3 October 2019 / Accepted: 11 April 2020 © Japanese Society of Gastroenterology 2020

Abstract Portal vein tumor thrombosis (PVTT) is an extremely locally advanced form of hepatocellular carcinoma. The natural median survival time of patients with hepatocellular carcinoma with PVTT is 2.7 to 4.0 months. A 63-year-old woman visited our clinic complaining of abdominal distention and appetite loss, which she had had for 3 weeks prior to admission. A contrastenhanced computed tomography scan showed double hepatocellular carcinomas with Type III PVTT and massive ascites caused by arterio-portal shunts within the PVTT. The ascites could not be treated by concentrated ascites reinfusion therapy or diuretics. Transarterial embolization using microspheres followed by radiation therapy against PVTT and five courses of transarterial chemoembolization using microspheres and cisplatin led to the maintaining of complete remission of both ascites and tumors for over 12 months after treatment. Fluoroglucose accumulation of PVTT showed 11.2 as a maximum standard uptake value on positron emission tomography before treatment. No fluoroglucose accumulation within PVTT was observed for over 12 months following treatment. Transarterial chemoembolization using microspheres followed by radiation therapy against Type III PVTT may result in drastic anti-cancer effects and improvement of both serum albumin and intractable ascites after treatment of arterio-portal shunts within the PVTT causing portal hypertension. Keywords  Hepatocellular carcinoma · Portal vein tumor thrombosis · Arterio-portal shunt · Transarterial chemoembolization · Radiation therapy

* Daizo Fukushima [email protected] 1



Department of Gastroenterology, Southern Tohoku General Hospital, 7‑115 Yatsuyamada, Koriyama, Fukushima 963‑8563, Japan

2



Department of Radiology, Southern Tohoku Research Institute for Neuroscience, 7‑115 Yatsuyamada, Koriyama 963‑8563, Japan

3

Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima 960‑1295, Japan

4

Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7‑172, Yatsuyamada, Koriyama, Fukushima 963‑8052, Japan

5

Department of Pathology, Southern Tohoku Research Institute for Neuroscience, 7‑115 Yatsuyamada, Koriyama 963‑8563, Japan







Abbreviations HCC Hepatocellular carcinoma PVTT Portal vein tumor thrombosis CT Computed tomography scan PIVKAII Protein induced by vitamin K absence or antagonist-II AP shunt Arterio-portal shunt CART​ Concentrated ascites reinfusion therapy EOB-MRI Gadoxetic acid-enhanced magnetic resonance imaging FDG-PET Fluoroglucos