A Case of Huge Hepatocellular Carcinoma with Extensive Portal Vein Tumor Thrombus, Successfully Treated with Multi-Model Therapy Including Ligation of Right Portal Vein, Radiofrequency-Ablation, and Postoperative Three-Dimensional Comformal Radiotherapy

Koutaro Hirashima, Toru Beppu, Takatoshi Ishiko, Kei Horino, Hiroyuki Komori, Toshiro Masuda, Hiromitsu Hayashi, Hirohisa Okabe, Masahiko Hirota and Hideo Baba

Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University

We report a case of hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) successfully treated with multimodel therapy. A 82-year-old man with HCC who had undergone transcatheter arterial chemoembolization (TACE) 4 times and admitted for rapidly elevated AFP was found in abdominal computed tomography (CT) to have HCC (S5) 6 cm in diameter with PVTT (Vp3) and two satellites (S4). When the high resection rate and poor liver function ruled out right hepatectomy, we conducted intraoperative ligation of the right portal vein and radiofrequency ablation (RFA) and three-dimensional postoperative comformal radiotherapy (total: 45 Gy). HCC recurred in the right liver alone at 6, 15, and 20 months after surgery. Percutaneous RFA was achieved for all of these lesions. Two years postoperatively, AFP remains within a normal range and the patient is doing very well without reccurrences. Operative portal ligation combined with RFA and three-dimensional postoperative comformal radiotherapy is thus quite useful in treating unresectable HCC with PVTT (Vp3).

Key words
ligation of right portal vein, portal vein tumor thrombus (PVTT), three-dimensional comformal radiotherapy

Reprint requests
Koutaro Hirashima Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University
1-1-1 Honjo, Kumamoto, 860-8556 JAPAN

Accepted
May 21, 2008

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