Tsurugai Yuichiro, Takeda Atsuya, Sanuki Naoko, Eriguchi Takahisa, Ueno Masayuki
Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura, JPN.
Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Kurashiki, JPN.
Cureus. 2021 Oct 9;13(10):e18624. doi: 10.7759/cureus.18624. eCollection 2021 Oct.
In clinical practice, the treatment approach for hepatocellular carcinoma (HCC) with macrovascular invasion (MVI) is determined on a case-by-case basis. The common management options include systemic and local therapies, although the former is the more widely accepted approach. We present three cases of HCC with MVI successfully treated with radiotherapy. The first patient was a 62-year-old man with Child-Pugh A cirrhosis who had a 5.7-cm treatment-naïve HCC invading the bilateral branches of the portal vein. Stereotactic body radiotherapy (SBRT) was administered, with no evidence of recurrence observed at the 24-month follow-up. The second patient was an 81-year-old man with Child-Pugh A cirrhosis who had a 3.8-cm HCC invading the inferior vena cava (IVC). Transcatheter chemoembolization performed one month earlier had been ineffective, and the tumor had grown rapidly. SBRT was administered, and no evidence of recurrence was observed up to his death from pneumonia 24 months after the treatment initiation. The third patient was a 72-year-old man with Child-Pugh A cirrhosis who had a 6.7-cm treatment-naïve HCC with portal vein tumor thrombosis (PVTT) from the main trunk to the secondary branches of both lobes. PVTT was treated with hypofractionated radiotherapy, while the primary HCC and intrahepatic recurrent lesions were subsequently treated with hepatic arterial infusion chemotherapy (HAIC) and five rounds of ablation. Six months after the last ablation (48 months after initial therapy), no evidence of recurrence was observed. Our cases illustrate that radiotherapy leads to the successful treatment of HCC with MVI.
在临床实践中，肝细胞癌（HCC）伴大血管侵犯（MVI）的治疗方法需根据具体病例确定。常见的治疗选择包括全身治疗和局部治疗，尽管前者是更被广泛接受的方法。我们展示了3例HCC伴MVI患者成功接受放疗的病例。首例患者为一名62岁男性，患有Child-Pugh A级肝硬化，有一个未经治疗的5.7 cm HCC侵犯门静脉双侧分支。给予立体定向体部放疗（SBRT），在24个月的随访中未观察到复发迹象。第二例患者为一名81岁男性，患有Child-Pugh A级肝硬化，有一个3.8 cm HCC侵犯下腔静脉（IVC）。一个月前进行的经导管动脉化疗栓塞无效，肿瘤迅速生长。给予SBRT，从治疗开始24个月直至其死于肺炎，均未观察到复发迹象。第三例患者为一名72岁男性，患有Child-Pugh A级肝硬化，有一个未经治疗的6.7 cm HCC，伴有从主干至两叶二级分支的门静脉肿瘤血栓形成（PVTT）。PVTT采用分割放疗，而原发性HCC和肝内复发病灶随后接受肝动脉灌注化疗（HAIC）和5轮消融治疗。最后一次消融后6个月（初始治疗后48个月），未观察到复发迹象。我们的病例表明，放疗可成功治疗HCC伴MVI。
