Dendy Meaghan S, Camacho Juan C, Ludwig Johannes M, Krasinskas Alyssa M, Knechtle Stuart J, Kim Hyun S
Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
Division of Vascular and Interventional Radiology, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC.
Transplant Direct. 2017 Aug 18;3(9):e206. doi: 10.1097/TXD.0000000000000707. eCollection 2017 Sep.
Infiltrative hepatocellular carcinoma with macrovascular invasion is a relatively rare presentation and usually fatal disease.
Both patients exceeded Milan and University of California-San Francisco (UCSF) criteria, and per Barcelona Clinic Liver Cancer group guidelines, they were enrolled in a prospective open-label radioembolization phase II trial that gave them optimized lobar doses of Yttrium-90 as solely the first-line therapy without concomitant or additional pharmacological or locoregional therapies.
Three months after radioembolization, the patients demonstrated no residual viable disease on surveillance imaging. The patients were then followed up with serial imaging for 2 years in 3-month intervals, without documenting recurrence or extrahepatic disease. Finally, both patients underwent transplantation and after more than 20 months of imaging surveillance, no locoregional or systemic recurrence have been observed.
We present, to our knowledge, the first 2 reports of transplantation after successfully downstaging infiltrative disease with portal vein tumoral thrombosis, which traditionally poses as a relative contraindication for resection or transplantation.
伴有大血管侵犯的浸润性肝细胞癌是一种相对罕见的表现形式，通常是致命性疾病。
两名患者均超过了米兰标准和加利福尼亚大学旧金山分校（UCSF）标准，根据巴塞罗那临床肝癌组指南，他们参加了一项前瞻性开放标签放射性栓塞II期试验，该试验仅给予他们优化的叶段剂量的钇-90作为一线治疗，不伴有或附加其他药物或局部区域治疗。
放射性栓塞三个月后，患者在监测影像上未显示残留的存活病灶。然后对患者进行为期2年、间隔3个月的系列影像随访，未记录到复发或肝外疾病。最后，两名患者均接受了移植手术，经过20多个月的影像监测，未观察到局部区域或全身复发。
据我们所知，我们首次报告了2例在成功降低伴有门静脉肿瘤血栓形成的浸润性疾病分期后进行移植的病例，而门静脉肿瘤血栓形成传统上是切除或移植的相对禁忌证。
