Treatment of hepatocellular carcinoma with arterioportal shunting using balloon-assisted transarterial yttrium-90 radiation segmentectomy: A case report

Abstract

Portal vein tumor thrombus (PVTT) is a common finding associated with hepatocellular carcinoma (HCC) often further complicated by arterioportal shunting. While radioembolization with Yttrium-90 (Y-90) is the preferred treatment for HCC with PVTT, shunting can complicate particle delivery. Here, we describe a case of a 65-year-old man with HCC and significant shunting from the segment IV hepatic artery into the left and right portal veins due to a PVTT. We performed a balloon-assisted radiation segmentectomy by occluding the hepatic artery supplying the PVTT to minimize arterioportal shunting and promote redistribution of particles into the tumor bed. Post Y-90 bremsstrahlung scan correlated with appropriate uptake. One-month follow-up magnetic resonance imaging demonstrated response to treatment with decreased tumor thrombus in the left portal vein. Here, we demonstrate that balloon-occlusion-assisted transarterial radiation segmentectomy could be a beneficial approach for improving tumor response and reducing complications in individuals with HCC and arterioportal shunting.