Complete pathological response induced by sorafenib for advanced hepatocellular carcinoma with multiple lung metastases and venous tumor thrombosis allowing for curative resection.
We report the first case of initially unresectable advanced hepatocellular carcinoma (HCC) with portal vein and hepatic venous tumor thrombosis and multiple lung metastases that allowed for curative hepatectomy after multidisciplinary treatment including sorafenib. A 54-year-old male presented with a large HCC in the right liver with tumor thrombosis of the left portal vein and middle hepatic vein (MHV) as well as multiple lung metastases. His serum alpha-fetoprotein level was elevated at 52,347 ng/mL and palliative treatment with sorafenib was initiated. One month later, a significant reduction in the serum AFP level, decrease in the tumor size with recanalization of the portal vein and the absence of lung metastases were noted. Three months after the start of sorafenib treatment, external-beam radiotherapy was performed to treat enlargement of the area of MHV thrombosis, and the thrombosis regressed. Five months after the initiation of sorafenib treatment, central bisegmentectomy associated with removal of the tumor thrombus in the inferior vena cava was performed. A microscopic examination revealed complete necrosis of the tumor. Sorafenib treatment may be a bridge to curative resection in selected patients with initially unresectable advanced HCC, even in cases involving multiple extrahepatic metastases.
['Kitajima|Toshihiro|T|', 'Hatano|Etsuro|E|', 'Mitsunori|Yusuke|Y|', 'Taura|Kojiro|K|', 'Fujimoto|Yasuhiro|Y|', 'Mizumoto|Masaki|M|', 'Okajima|Hideaki|H|', 'Kaido|Toshimi|T|', 'Minamiguchi|Sachiko|S|', 'Uemoto|Shinji|S|']
D000970:Antineoplastic Agents D006528:Carcinoma, Hepatocellular D003131:Combined Modality Therapy D006498:Hepatectomy D006503:Hepatic Veins D006801:Humans D008113:Liver Neoplasms D008175:Lung Neoplasms D008297:Male D008875:Middle Aged D009536:Niacinamide D010671:Phenylurea Compounds D011169:Portal Vein D000077157:Sorafenib D020246:Venous Thrombosis
Sorafenib Hepatocellular carcinoma Lung metastases Hepatectomy Complete response