Recurrence-Free Survival of a Hepatocellular Carcinoma Patient With Tumor Thrombosis of the Inferior Vena Cava After Treatment With Sorafenib and Hepatic Resection
Recurrence-Free Survival of a Hepatocellular Carcinoma Patient With Tumor Thrombosis of the Inferior Vena Cava After Treatment With Sorafenib and Hepatic Resection
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DOI：
10.9738/intsurg-d-14-00133.1
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发表时间：
2015-05-01
影响因子：
0.1
通讯作者：
Baba, Hideo
中科院分区：
文献类型：
--
作者：
Nakamura, Kenichi;Beppu, Toru;Baba, Hideo
索拉非尼(Nexabar，拜耳，德国柏林)是一种多激酶抑制剂，很少能降级晚期肝细胞癌(HCC)。有报道称，索拉非尼联合其他手段，如经导管肝动脉化疗栓塞术(TACE)或放射治疗，可能是通往手术的桥梁。我们观察到一例进展性肝细胞癌合并肝静脉癌栓进入下腔静脉(IVC-HVTT)的病例，在包括索拉非尼在内的多学科治疗后转为可行的根治性切除。由于这种治疗，病人成功地接受了切除。患者男，45岁，患有乙肝病毒相关性慢性肝炎，经IVC-HVTT确诊为肝细胞癌。为了获得肿瘤的根治性切除，我们进行了TACE，放射治疗，然后使用索拉非尼(800 mg/d，共72g)。包括IVC-HVTT在内的肿瘤明显缩小，因此，我们成功地进行了扩大的后部切除和IVC-HVTT的全切除。手术时间736分钟，术中出血量805毫升。无术后并发症发生。术后4周开始应用索拉非尼辅助治疗，持续6个月，800 mg/d，共144g。患者从最初的治疗到现在已经存活了大约4年，没有复发。综合治疗包括索拉非尼、TACE、放射治疗和肝切除可能是治疗合并IVC-HVTT的肝细胞癌患者的有效策略。
Sorafenib (Nexabar, Bayer, Berlin, Germany), one of multikinase inhibitors, can infrequently downstage advanced hepatocellular carcinoma (HCC). There are some reports that sorafenib in combination with other modalities, such as transcatheter arterial chemoembolization (TACE) or radiation therapy, could represent a bridge to surgery. We have observed a progressive HCC case with hepatic vein tumor thrombosis proceeding to the inferior vena cava (IVC-HVTT) convert to a state of feasible curative resection after a multidisciplinary treatment which included sorafenib. The patient underwent a successful resection in consequence of this therapy. A 45-year-old male with Hepatitis B Virus-associated chronic hepatitis was diagnosed as HCC with IVC-HVTT. To obtain oncological curative resection, we performed TACE, radiation therapy followed by administration of sorafenib (800 mg per day, total 72 g). The tumor including IVC-HVTT remarkably shrank, therefore, an extended posterior sectionectomy and total removal of the IVC-HVTT was successfully performed. The operation time was 736 minutes and the amount of intraoperative hemorrhage was 805 mL. No postoperative complication occurred. Adjuvant therapy with sorafenib was started four weeks after the operation and continued for 6 months (800 mg per day, total 144 g). The patient is alive without recurrence for about 4 years from the initial therapy. Multidisciplinary therapy including sorafenib, TACE, radiation, and hepatic resection may be an effective strategy to treat HCC patients with IVC-HVTT.