Abstract
BackgroundAlthough the effectiveness of perioperative adjuvant therapy in the treatment of hepatocellular carcinoma (HCC) has been investigated, the efficacy of preoperative therapy is unclear. Herein, we report a case of pathological complete response after percutaneous isolated hepatic perfusion (PIHP) for HCC involving portal vein tumor thrombosis (PVTT).Case presentationA 77-year-old woman was referred to our institute with a liver mass detected on a routine health screening. Computed tomography revealed a 28 × 25 mm HCC in the left lobe of the liver and a tumor thrombus in the left and right portal branches (T4N0M0, stage IVA). The patient received a single dose of preoperative PIHP with doxorubicin plus mitomycin C, without severe toxicity. After the chemotherapy, she underwent extended left hepatic lobectomy and thrombectomy of the PVTT. No cancer cells were detected during histopathological analysis, indicating pathological complete response. She remained relapse-free 12 months after the surgery.ConclusionsWe experienced a case of pathological complete response after preoperative PIHP with doxorubicin plus mitomycin C for HCC involving PVTT.
Highlights
The effectiveness of perioperative adjuvant therapy in the treatment of hepatocellular carcinoma (HCC) has been investigated, the efficacy of preoperative therapy is unclear
We experienced a case of pathological complete response after preoperative percutaneous isolated hepatic perfusion (PIHP) with doxorubicin plus mitomycin C for HCC involving portal vein tumor thrombosis (PVTT)
Laboratory data were as follows: platelet count 126 K/uL, total bilirubin 0.8 mg/dL, aspartate aminotransferase (AST) 176 U/L, alanine aminotransferase (ALT) 157 U/L, albumin 4.2 g/dL, prothrombin time 90.6 %, indocyanine green 15-min retention test (ICG R15) 19.7 %, α-fetoprotein (AFP) 16 ng/mL, protein induced by vitamin K absence or antagonist II (PIVKA-II) 2873 mAU/mL, hepatitis C virus (HCV) Ab positive, HCV RNA 6.54 logIU/mL
Summary
Further investigation into surgery following neoadjuvant chemotherapy as a possible therapeutic option for HCC involving PVTT is warranted. PIHP with doxorubicin plus mitomycin C is a feasible and promising preoperative chemotherapy for HCC involving PVTT. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Abbreviations AFP, alpha-fetoprotein; ALT, alanine aminotransferase; AST, aspartate aminotransferase; BCLC, the Barcelona Clinic Liver Cancer; CT, computed tomography; HAI, hepatic arterial infusion; HCC, hepatocellular carcinoma; ICG R15, indocyanine green 15-min retention test; OS, overall survival; PIHP, percutaneous isolated hepatic perfusion; PIVKA-II, protein induced by vitamin K absence or antagonist II; PVTT, portal vein tumor thrombosis; TE, treatment efficacy. All authors read and approved the final manuscript. Ethics approval and consent to participate The study protocol about PIHP was approved by the Kobe University Hospital institutional review board
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