Журнал клинических случаев

Successful Down-staging of Hepatocellular Carcinoma with Intra-arterial Therapy Prior to Liver Transplantation: A Case Report

Abstract

Hideki Iwamoto, Hiroaki Nagamatsu, Takashi Niizeki, Shigeo Shimose, Tomotake Shirono, Hironori Koga, Akinobu Taketomi, Ryoko Kuromatsu and Takuji Torimura

Background: Down-staging strategy of Hepatocellular carcinoma (HCC) prior to Liver Transplantation (LT) is important for preventing drop-out from the waiting list for LT or further enlargement of the adaptation of LT. Hepatic arterial infusion chemotherapy with cisplatin in lipiodol and 5-fluorouracil (HAIC with lipiodol) is a novel and effective treatment for advanced HCC. Here we report a successful down-staging case of HCC by a series of therapeutic strategies using HAIC with lipiodol that provided an effective bridge to LT. Case Report: We report a 48-year-old patient with severe liver cirrhosis, a 7.5 cm primary HCC in segment 8 and a 1.2 cm satellite lesion in segment 4, which was outside both Milan Criteria and University of California, San Francisco (UCSF) Criteria. We offered HAIC with lipiodol therapy using a temporary indwelling catheter system with intent to down-stage prior to LT. Six months after initial treatment, complete tumor remission was achieved. However, the patient developed HCC recurrence within the Milan Criteria on further six months later, and LT was performed. Examination of the explant revealed pathologic complete response of both primary and satellite lesions treated by HAIC with lipiodol showed pathologically complete necrosis. This patient is free from recurrence 5 years after LT. Conclusion: HAIC with lipiodol using a temporary indwelling catheter system may be effective to down-stage HCC prior to LT.