A Case of Huge Hepatocellular Carcinoma with Extensive Portal Vein Tumor Thrombus, Successfully Treated with Multi-Model Therapy Including Ligation of Right Portal Vein, Radiofrequency-Ablation, and Postoperative Three-Dimensional Comformal Radiotherapy

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  • Hirashima Koutaro
    Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University
  • Beppu Toru
    Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University
  • Ishiko Takatoshi
    Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University
  • Horino Kei
    Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University
  • Komori Hiroyuki
    Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University
  • Masuda Toshiro
    Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University
  • Hayashi Hiromitsu
    Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University
  • Okabe Hirohisa
    Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University
  • Hirota Masahiko
    Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University
  • Baba Hideo
    Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University

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  • 高度門脈腫瘍栓を伴う切除不能な大型肝細胞癌に対し門脈結紮・ラジオ波凝固療法・３次元原体照射による併用療法が著効した１例

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Abstract

We report a case of hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) successfully treated with multimodel therapy. A 82-year-old man with HCC who had undergone transcatheter arterial chemoembolization (TACE) 4 times and admitted for rapidly elevated AFP was found in abdominal computed tomography (CT) to have HCC (S5) 6cm in diameter with PVTT (Vp3) and two satellites (S4). When the high resection rate and poor liver function ruled out right hepatectomy, we conducted intraoperative ligation of the right portal vein and radiofrequency ablation (RFA) and three-dimensional postoperative comformal radiotherapy (total: 45Gy). HCC recurred in the right liver alone at 6, 15, and 20 months after surgery. Percutaneous RFA was achieved for all of these lesions. Two years postoperatively, AFP remains within a normal range and the patient is doing very well without reccurrences. Operative portal ligation combined with RFA and three-dimensional postoperative comformal radiotherapy is thus quite useful in treating unresectable HCC with PVTT (Vp3).

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