Possibility of five-year survival in the treatment of advanced hepatocellular carcinoma by interventional radiology methods

Abstract

Treatment of hepatocellular carcinoma (HCC) at intermediate and advanced stages is a big problem. Locoregional methods of treatment were previously mainly used in compliance with the «Milan criteria» (adopted from a 1996 study as the guideline for the management of patients with cirrhosis and HCC), and sorafenib was used as a chemotherapy drug with proven efficacy. In real clinical practice, hematological toxicity, pronounced concomitant pathology and the general condition of the patient limit the treatment. Even if all conditions were met, in the randomized SHARP study, in patients with HCC at stage BCLC «C» treated with sorafenib, the median overall survival was only 10.7 months. The status of liver cirrhosis is also an important prognostic factor. In the presented clinical observation, in a 67-year-old patient with HCC 2a stage T3N0M0, initially BCLC «B» with severe liver cirrhosis and multiple concomitant pathology, an attempt to use Sorafenib led to persistent thrombocytopenia. However, thanks to multi-stage interventional radiological interventions, including: intra-arterial chemoinfusion, superselective chemoembolization of tumor vessels with drug-saturated hepaspheres, chemoembolization of tumors with fat-soluble contrast emulsion followed by radiofrequency thermal ablation, it was possible to achieve long-term control and exceed the five-year survival threshold.