Markedly effective local control of hepatocellular carcinoma with a poor prognosis by combined multimodal therapy with sorafenib as a neoadjuvant approach.

Sorafenib has recently been approved as the gold standard therapy for advanced BCLC-C hepatocellular carcinomas. Although significant improvement of survival rates was shown, objective tumor response rates remained low following RECIST criteria in phases 2 and 3 studies. We report the rare case of a patient with a large hepatocellular carcinoma tumor invading suprahepatic veins in which sorafenib led to a very significant regression by about 90% of the tumor bulk, thus allowing at sterilizing the residual tumor tissue by subsequent combination of transarterial intrahepatic chemoembolization and high dose radiotherapy.