Abscopal complete regression of hepatocellular carcinoma with multiple pleural metastases
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CASE REPORT
Abscopal complete regression of hepatocellular carcinoma with multiple pleural metastases Kenta Ohmatsu1 · Yaichiro Hashimoto1 · Miki Kawanishi1 · Yuka Ishii1 · Sawa Kono1 · Shigehiko Kuribayashi1 · Shunichi Ariizumi2 · Kumiko Karasawa1 Received: 24 June 2020 / Accepted: 6 September 2020 © The Japan Society of Clinical Oncology 2020
Abstract Hepatocellular carcinoma (HCC) with extrahepatic metastasis is rare, and its prognosis is extremely poor. There is no standard treatment for HCC with extrahepatic metastasis. We report a case of abscopal effect in HCC with multiple pleural metastases in a patient who was treated with focal radiotherapy to extrahepatic metastasis, and achieved long-term survival. We performed radiotherapy only to the tumor in inferior vena cava and the proximal pleural tumor. The regimen comprised a total dose of 30 Gy administered in ten fractions to these tumors, followed by 12 Gy administered in four fractions (a total of 42 Gy in 14 fractions) as boost irradiation to the remaining tumor, and a complete regression was achieved. There have been some case reports on abscopal effects in HCC, but no reports on patients with multiple pleural metastases. To our knowledge, this is the first case report on the abscopal effect of focal radiotherapy resulting in complete regression of distant multiple pleural metastases. Keywords Abscopal effect · Radiotherapy · Hepatocellular carcinoma · Pleural metastasis
Introduction Hepatocellular carcinoma (HCC) with multiple extrahepatic metastases is rare, with an incidence of 2–18% at the time of surgery or following autopsy [1]. HCC with extrahepatic metastases generally presents with advanced intrahepatic lesions, and there has been no standard treatment for this condition. The prognosis in patients with HCC with extrahepatic metastases is extremely poor; conventional palliative therapy yields an overall survival duration of only 6–14 months [2]. Other authors have reported that the median survival duration is no longer than 6 months in most cases, even with some treatment [3–5]. In general, the currently recommended treatment modality for HCC with extrahepatic metastasis is molecularly targeted therapy using
drugs such as sorafenib or lenvatinib [6–8]. However, there are often situations wherein intrahepatic lesions can be controlled; and local treatments, including radiotherapy, can be considered for extrahepatic lesions. In recent years, the abscopal effect has gained attention in the field of radiation oncology. The abscopal effect is a phenomenon observed in the treatment of metastatic carcinoma whereby shrinkage of untreated tumors occurs concurrently with shrinkage of tumors within the scope of the localized treatment. There have been some case reports of abscopal effects in HCC [9–11], but no such reports among patients with multiple pleural metastases. To our knowledge, this is the first report on the abscopal effect with focal radiotherapy resulting in complete regression of distant multiple pleural metastases.
* Yaichiro Hashimoto
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