Transarterial Radioembolization for the Treatment of Advanced Hepatocellular Carcinoma Invading the Right Atrium
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CASE REPORT
INTERVENTIONAL ONCOLOGY
Transarterial Radioembolization for the Treatment of Advanced Hepatocellular Carcinoma Invading the Right Atrium Raphae¨l Girardet1 • Sarah Boughdad2 • Antonia Digklia3 • Catherine Beigelman1 Marie Meyer2 • Niklaus Schaefer2 • Mathilde Vermersch1 • Arnaud Hocquelet1 • Georgia Tsoumakidou1 • Alban Denys1 • Rafael Duran1
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Received: 30 May 2020 / Accepted: 21 July 2020 The Author(s) 2020
Abstract Hepatocellular carcinoma (HCC) has the tendency to invade the portal and/or hepatic venous system. The invasion of the right atrium is uncommonly observed and constitutes a treatment challenge. We report the case of a patient with HCC invading the right atrium treated with 90 Yttrium-transarterial radioembolization (90Y-TARE). Following the treatment, organizing pneumonia secondary to nivolumab occurred, raising the question of an interaction between 90Y-TARE and nivolumab. Keywords HCC Radioembolization Immune pneumonitis
Introduction Data about the treatment of hepatocellular carcinoma (HCC) invading the right atrium is scarce. A few reports investigated different strategies (surgery, radiofrequency ablation, transarterial chemoembolization (TACE), radiation therapy or chemotherapy) [1–4]. However, there is no consensus. The prognosis is dismal with or without treatment (median survival: 1–4 months) [5]. We report the case of a patient with HCC invading the right atrium who benefited from 90Yttrium-transarterial radioembolization (90Y-TARE). We discuss the rationale and risks of 90Y-TARE in this subgroup of patients.
Case
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00270-020-02605-3) contains supplementary material, which is available to authorized users. & Rafael Duran [email protected] 1
Department of Radiology and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
2
Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
3
Department of Medical Oncology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
Patient’s specific consent was obtained for this report. A 71-year-old male with alcoholic cirrhosis (Child–Pugh A5) presented in the emergency department with abdominal pain and hemodynamic instability. CT scan showed multifocal HCC involving segments II, VII, VIII, with spontaneous rupture of a 9-cm tumor (segment VII), and hemoperitoneum. The patient was successfully treated with superselective Gelfoam embolization, with complete tumor necrosis on follow-up imaging. Several locoregional treatments of the remaining lesions were performed over an 18-month period; conventional TACE (cTACE) of left liver and segments VII/VIII, and radiofrequency ablation of tumor in segment VIII. The a-fetoprotein dropped from 182 to 15.3 ng/ml. Five months after the last treatment, follow-up imaging showed a tumor thrombus invading the right hepatic vein, inf
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