Long-term survival of 11\xa0years with multidisciplinary therapy for hepatocellular carcinoma metastasis to the ovary and peritoneum: a case report

Satoko Motegi,Kohei Ogawa,Ken-Ichi Mizuno,Rie Azumi,Yuzo Kawata,Ryosuke Nozawa,Takeshi Suda,Hirokazu Kawai,Shuji Terai,Takeshi Yokoo,Toru Setsu,Hajime Umezu,Koji Nishino

doi:10.1007/s12328-021-01434-2

Abstract

We herein report a rare case of HCC metastases to the ovary and peritoneum in a 61-year-old female patient who has achieved 11-year survival with multidisciplinary therapy. The patient was diagnosed with HCC during balloon angioplasty performed for Budd–Chiari syndrome in 1994 and underwent partial hepatectomy twice. Five years after the second hepatectomy, allochronic recurrence of a single nodule detected in S8 was treated by radiofrequency ablation, followed by percutaneous ethanol injection therapy and stereotactic body radiotherapy. However, her α-fetoprotein level rose to 1862 ng/mL within one year and computed tomography revealed a large pelvic tumor suggesting HCC metastasis to the ovary. The subsequent laparotomy revealed one 11-cm left ovarian tumor, one small right ovarian nodule, and numerous peritoneal nodules. Bilateral salpingo-oophorectomy and peritoneal resection of as many nodules as possible were performed. Combination therapy with intravenous 5-fluorouracil plus cisplatin and ramucirumab monotherapy effectively suppressed tumor progression with maintenance of hepatic functional reserve, and she has achieved long-term survival of 11 years, illustrating that multidisciplinary therapy with favorable hepatic functional reserve maintenance can contribute to long-term survival in HCC with extrahepatic spread.

Highlights

The lungs, lymph nodes, bones, and adrenal glands are the most common metastatic sites, and the reported median survival after the diagnosis of extrahepatic spread is 8.1 months [1]
In March 2015, the patient developed anaphylactic reaction to iodine-containing contrast oteracil, FAIT Fluorouracil arterial infusion and interferon therapy, UFT tegafur/uracil, SOR sorafenib, RAM ramucirumab, RFA radiofrequency ablation, PEIT percutaneous ethanol injection therapy, SBRT stereotactic body radiation therapy, TACE transarterial chemoembolization medium, leading to the contraindication of TACE and contrast-enhanced computed tomography (CT); the patient was treated with 5-fluorouracil-based regimens, such as intravenous 5-fluorouracil plus interferon α-2a, and tegafur/uracil monotherapy
Only 16 living cases of HCC metastasis to the ovary have been reported except the present case (Table 2) [2,3,4,5,6,7,8,9,10,11,12,13,14,15]

Summary

Introduction

The lungs, lymph nodes, bones, and adrenal glands are the most common metastatic sites, and the reported median survival after the diagnosis of extrahepatic spread is 8.1 months [1]. Oteracil, FAIT Fluorouracil arterial infusion and interferon therapy, UFT tegafur/uracil, SOR sorafenib, RAM ramucirumab, RFA radiofrequency ablation, PEIT percutaneous ethanol injection therapy, SBRT stereotactic body radiation therapy, TACE transarterial chemoembolization medium, leading to the contraindication of TACE and contrast-enhanced CT; the patient was treated with 5-fluorouracil-based regimens, such as intravenous 5-fluorouracil plus interferon α-2a, and tegafur/uracil monotherapy. The patient has been able to maintain improved quality of life and good performance status for 11 years after the initial diagnosis of HCC metastases to the ovary and peritoneum. Because her mALBI score has exhibited only a slight increase from − 2.45 to − 2.30 despite the long-term treatment, multidisciplinary treatment has been ongoing

Discussion

Findings

43 Hepatectomy RFA