Liver transplantation following two conversions in a patient with huge hepatocellular carcinoma and portal vein invasion:A case report  

作　　者：Li-Cong Liang Wen-Sou Huang Zhao-Xiong Guo Hong-Ji You Yong-Jian Guo Ming-Yue Cai Li-Teng Lin Guo-Ying Wang Kang-Shun Zhu 

机构地区：[1]Department of Minimally Invasive Interventional Radiology,The Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 510260,Guangdong Province,China [2]Department of Nuclear Medicine,The Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 510260,Guangdong Province,China [3]Department of Hepatobiliary Surgery,The First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,Guangdong Province,China

出　　处：《World Journal of Gastroenterology》2024年第36期4071-4077,共7页世界胃肠病学杂志（英文版）

摘　　要：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.

关 键 词：Hepatocellular carcinoma Two conversions Liver transplantation Yttrium-90 resin microspheres Transarterial chemoembolization Hepatic arterial infusion chemotherapy Case report 

分 类 号：R735.7[医药卫生—肿瘤]