Treatment of hepatocellular carcinoma with hepatic vein tumor thrombosis protruding into the inferior vena cava by conversion surgery following chemotherapy with regorafenib: a case report

Kazuhisa Takeda,Tetsuya Shimizu,Chikara Kunisaki,Hitoshi Sekido,Yu Kogure,Satoshi Kobayashi,Koichi Mori,Manabu Morimoto,Goro Matsuda,Kentaro Araki,Yuji Yamamoto,Itaru Endo,Yuji Tsurumaru,Kazuya Nakagawa,Hitoshi Niino

doi:10.1007/s12328-019-01077-4

Abstract

Regorafenib is an oral multikinase inhibitor affecting angiogenesis, oncogenesis, metastasis, and tumor immunity. As a systemic treatment, it has been shown to provide survival benefits in hepatocellular carcinoma (HCC) patients progressing on sorafenib treatment. We report herein a case of HCC with hepatic vein tumor thrombosis protruding into the inferior vena cava (IVC-HVTT) which was successfully treated by surgery following second-line chemotherapy with regorafenib. A 79-year-old man with chronic hepatitis was diagnosed with HCC. Computed tomography revealed a solitary tumor in segments 7 and 8 and an IVC-HVTT from the right hepatic vein. Since IVC-HVTT removal is a difficult procedure, the tumor was diagnosed as unresectable, and administration of sorafenib was started. Five weeks later, the lesion had increased in size by 15.3%; subsequently, regorafenib was given as second-line therapy for 12 months. After shrinkage of the IVC-HVTT, the patient was referred to our hospital for surgery. One month after the cessation of regorafenib, an extended resection of segment 8 and total removal of the IVC-HVTT was successfully performed without using total hepatic vascular exclusion. There were no serious postoperative complications. Additionally, there has been no recurrence for about 2 years since the initial therapy.

Highlights

The treatment strategy for hepatocellular carcinoma (HCC) is well established by the American Association for the Study of Liver Diseases [1] as well as the European Association for the Study of the Liver-European Organization for Research and Treatment of Cancer (EASL-EORTC) guidelines [2]
We report a case of locally advanced unresectable HCC with hepatic vein tumor thrombosis protruding to the inferior vena cava (IVC-HVTT), which was treated successfully by conversion surgery following second-line chemotherapy with regorafenib
For patients with HCC accompanied by vascular invasion, embolization, hepatectomy, hepatic arterial infusion chemotherapy, and molecular targeted therapy are recommended

Summary

Introduction

The treatment strategy for hepatocellular carcinoma (HCC) is well established by the American Association for the Study of Liver Diseases [1] as well as the European Association for the Study of the Liver-European Organization for Research and Treatment of Cancer (EASL-EORTC) guidelines [2]. There have been no reports of conversion surgery for HCC performed after the use of regorafenib as second-line chemotherapy. We report a case of locally advanced unresectable HCC with hepatic vein tumor thrombosis protruding to the inferior vena cava (IVC-HVTT), which was treated successfully by conversion surgery following second-line chemotherapy with regorafenib. The patient was diagnosed with unresectable HCC at his previous hospital because total hepatic vascular exclusion (THVE) would be necessary for the removal of the IVCHVTT and it was judged technically difficult to perform; in. At his first visit to our hospital, the patient’s Eastern Cooperative Oncology Group performance status was 0. The resected margin of the cut surface of the liver did not show any cancer cells, indicative

Discussion

Findings

Compliance with ethical standards