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Complete response of a hepatocellular carcinoma with complex macrovascular invasion after combined treatment with chemoembolization and immunotherapy: a case report

Journal Volume 84 - 2021
Issue Fasc.2 - Case reports
Author(s) A.-M. Bucalau 1, I. Tancredi 2, M. Pezzullo 3, A. Covas 4, G. Verset 1
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PAGES 371-374
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DOI10.51821/84.2.371
Affiliations:
(1) Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels
(2) Department of Interventional Radiology, Hôpital Erasme, Brussels
(3) Department of Radiology, Hôpital Erasme, Brussels
(4) Department of Gastroenterology, Marie Curie Hospital, Charleroi

Hepatocellular carcinoma accounts for 90% of primary liver cancers and represents a growing health problem worldwide. We report the complex case of a 71 year-old patient diagnosed with a large hepatocellular carcinoma and presenting an extensive vascular invasion of the middle hepatic vein and the inferior caval vein ascending to the right atrium with no extrahepatic spread. Due to several comorbidities, a systemic treatment by tyrosine kinase inhibitors was contraindicated. After discussion at the multidisciplinary hepatology tumor board, he was referred for selective internal radiation therapy. Unfortunately, the work-up showed an important lung shunt not allowing radioembolization. No clear recommendations are available in this situation. The decision was made to propose a combination treatment by transarterial chemoembolization, that was performed using a new generation of radio-opaque microspheres loaded with doxorubicin, followed by immunotherapy. This allowed a complete response with a very good quality of life.

Keywords: Transcatheter arterial chemoembolization (TACE), selective internal radiation therapy (SIRT), hepatocellular carcinoma (HCC), immunotherapy.

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