Journal of Liver Cancer

Case Reports

Multidisciplinary treatment with immune checkpoint inhibitors for advanced stage hepatocellular carcinoma: Ahlim Lee, Jaejun Lee, Hyun Yang, Soo-Yoon Sung, Chang Ho Jeon, Su Ho Kim, Moon Hyung Choi, Young Joon Lee, Ho Jong Chun, Si Hyun Bae; J Liver Cancer. 2022;22(1):75-83. Published online March 18, 2022; DOI: https://doi.org/10.17998/jlc.2022.03.04

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Hepatocellular carcinoma (HCC) is a cytotoxic chemotherapy-resistant tumor and most HCCs arise in a background of liver cirrhosis of various causes. Although the IMBrave150 trial showed remarkable advancements in the treatment of unresectable HCC with atezolizumab plus bevacizumab (AteBeva), therapeutic outcomes were unsatisfactory in more than half of the patients. Accordingly, many ongoing trials combine conventional modalities with new drugs such as immune checkpoint inhibitors for better treatment outcomes, and they are expected to benefit patients with limited responses to conventional treatment. Here, two patients with advanced stage HCC with preserved liver function and good performance status showed partial response after treatment with combination or sequential therapy of AteBeva, hepatic arterial infusion chemotherapy, radiation therapy, and transarterial chemoembolization. These findings indicate the efficacy of multidisciplinary treatment against advanced HCC. Additional studies are required to establish optimal treatment strategies.

Citations

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Complications of immunotherapy in advanced hepatocellular carcinoma
Young-Gi Song, Jeong-Ju Yoo, Sang Gyune Kim, Young Seok Kim
Journal of Liver Cancer.2024; 24(1): 9. CrossRef
Feasibility of additional radiotherapy in patients with advanced hepatocellular carcinoma treated with atezolizumab plus bevacizumab
Tae Hyun Kim, Bo Hyun Kim, Yu Ri Cho, Young-Hwan Koh, Joong-Won Park
Journal of Liver Cancer.2023; 23(2): 330. CrossRef
Is multidisciplinary treatment effective for hepatocellular carcinoma with portal vein tumor thrombus?
Won Hyeok Choe
Journal of Liver Cancer.2022; 22(1): 1. CrossRef

Liver Transplantation after Successful Downstaging with Hepatic Arterial Infusion Chemotherapy in a Patient with Hepatocellular Carcinoma with Portal Vein Tumor Thrombus: Hee Chul Nam, Pil Soo Sung, Ho Jong Chun, Dong Goo Kim, Jeong Won Jang, Jong Young Choi, Seung Kew Yoon; J Liver Cancer. 2019;19(1):64-68. Published online March 31, 2019; DOI: https://doi.org/10.17998/jlc.19.1.64

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Abstract PDF: Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide. The majority of patients with HCC are diagnosed at advanced disease stages with vascular invasion, where curative approaches are often not feasible. Currently, sorafenib is the only available standard therapy for HCC with portal vein tumor thrombosis (PVTT). However, in many cases, sorafenib therapy fails to achieve satisfactory results in clinical practice. We present a case of advanced HCC with PVTT that was treated with hepatic arterial infusion chemotherapy (HAIC) followed by liver transplantation. Three cycles of HAIC treatment resulted in necrotic changes in most of the tumors, and PVTT was reduced to an extent at which liver transplantation was possible. Further studies are required to determine the treatment strategies for advanced HCC with PVTT that can improve prognosis.

Review Article

Transarterial Approach in Early Stage HCC: From Palliative Therapy to Curative Therapy: Jung Suk Oh, Ho Jong Chun; Journal of the Korean Liver Cancer Study Group. 2012;12(2):93-96. Published online September 30, 2012

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Abstract PDF: Early stage hepatocellular carcinoma (HCC) based on BCLC staging system can be curatively treated by liver transplantation, surgical resection or percutaneous ablation. However, transarterial approaches, including transarterial chemoembolization (TACE) or transarterial radioembolization (TARE), are standard of care for intermediate stage HCC and can be an alternative treatment in the patients with early stage HCC which are unresectable, unsuitable for percutaneous ablation, or not eligible for liver transplantation. Many previous TACE studies in early stage HCC revealed that the overall survival rate was competitive with those of curative therapies considering their operation risks, but recurrence-free survival rate was significantly lower than curative therapies. Moreover, the histopathologic reports about TACE in early stage HCC demonstrated that only 38% of the HCC nodules were completely necrotic after TACE and only 81% of the nodules with complete response by EASL criteria showed complete necrosis. Although there is no long-term survival data about TARE in early stage HCC, a histopathologic report about TARE showed that 73% of the HCC nodules were completely necrotic after TARE and 100% of the nodules with complete response by EASL criteria showed complete necrosis. In conclusion, TACE is now limited to be categorized into a curative therapy in early stage HCC, according to the previous data about TACE. However, new recent technologies including C-arm CT, superselective embolization technique, drug-eluting bead (DEB) may sufficiently improve the survival data of TACE to prove its curative role. Considering its RFA-comparable histopathologic tumor response, TARE may prove to be a potential curative therapeutic for early stage HCC.

Case Reports

A Case of Hepatocellular Carcinoma which Showed Response to Transarterial Chemoembolization with DC Bead® in the Patient who Showed No Response to Conventional Transarterial Chemoembolization: Do Seon Song, Hee Yeon Kim, Myeong Jun Song, Si Hyun Bae, Jong Young Choi, Seung Kew Yoon, Ho Jong Chun; Journal of the Korean Liver Cancer Study Group. 2012;12(2):133-136. Published online September 30, 2012

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Abstract PDF: Hepatocellular carcinoma (HCC) is one of the most important cause of cancer death in South Korea. Approximately two thirds of the HCC patients are diagnosed in the unresectable stage. Conventional transarterial chemoembolization (TACE) showed survival benefit in the unresectable HCC patients, but it had some limitations, such as low response rate and systemic toxicity. Drug eluting bead has been reported low systemic toxicity and higher tumor necrosis rate. We report a case which showed response to TACE with DC bead in patient that showed no response to conventional TACE.

A Case of Hepatocellular Carcinoma in a 10 Year Old Child Treated with Yttrium Radioembolization and Transarterial Chemoembolization: Sung Won Lee, Hee Yeon Kim, Do Seon Song, Chung-Hwa Park, Myeong Jun Song, Jong Young Choi, Seung Kew Yoon, Jung Suk Oh, Ho Jong Chun, Si Hyun Bae; Journal of the Korean Liver Cancer Study Group. 2012;12(2):137-140. Published online September 30, 2012

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Abstract PDF: Hepatocellular carcinoma (HCC) in childhood is rare but is the second most common malignant liver neoplasm after hepatoblastoma in children. Surgical resectability is the foundation of curative therapy but only one third of newly diagnosed HCCs are resectable, and unresectable HCC remains largely unresponsive to systemic chemotherapy. In all reported series of HCC in children, therapeutic results are poor with overall survival less than 30%. Systemic chemotherapy is only partially effective but if preoperative downstaging can be achieved, it would result in a higher survival rate. There are scarce data regarding local ablative treatments such as transarterial chemoembolization (TACE) and therefore survival benefits are still unclear. TACE may be considered as a therapeutic alternative in cases of unresectable tumors after systemic chemotherapy or in unresectable, non-metastatic HCCs. The use of orthotopic liver transplantation in childhood HCC remains controversial. Radioembolization is a mode of treatment that aims to selectively target radiation to all liver tumors using yttrium-90 microspheres while limiting the dose to normal liver parenchyma. It may be considered as another treatment option in childhood HCC with the purpose of preoperative downstaging but further studies are required to determine the treatment benefits and safety of radioembolization treatment.

A Case of Progressive Superior Mesenteric Vein Thrombosis after Percutaneous Transhepatic Obliteration in Infiltrative Hepatocellular Carcinomaswith Portal Vein Thrombosis: Hee Yeon Kim, Chung-Hwa Park, Sung won Lee, Do Seon Song, Myeong Jun Song, Jong Young Choi, Seung Kew Yoon, Si Hyun Bae, Jung Suk Oh, Ho Jong Chun; Journal of the Korean Liver Cancer Study Group. 2012;12(2):146-150. Published online September 30, 2012

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Abstract PDF: Percutaneous transhepatic obliteration of gastroesophageal varices is one of the effective emergency procedure when endoscopic therapy is not indicated or has been failed. One of the major complications of this procedure is portal thrombosis. A 53-year-old male with hepatitis B virus infection was diagnosed of infiltrative hepatocellular carcinoma with right portal vein thrombosis. On the next day after being hospitalization, the patient developed variceal bleeding. With medical management, endoscopic therapy was initially attempted, however, it ended in failure. Emergency percutaneous transhepatic obliteration of bleeding gastroesophageal varices was considered as a next option. Bleeding from gastroesophageal varices was stopped after percutaneous obliateration, however, portal thrombosis was extended to splenic vein or superior mesenteric veins.

A Case of Liver Transplantation after Combination of Sorafenib and Hepatic Arterial Infusion Chemotherapy in the Advanced Hepatocellular Carcinoma Patient with Portal Vein Thrombosis: Do Seon Song, Myeong Jun Song, Si Hyun Bae, Jong Young Choi, Seung Kew Yoon, Ho Jong Chun, Dong Goo Kim; Journal of the Korean Liver Cancer Study Group. 2012;12(1):62-66. Published online February 28, 2012

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Abstract PDF: Hepatocellular carcinoma (HCC) is the third most common malignancy in Korea where chronic hepatitis B virus is prevalent. More than 60-70% of HCC cases are diagnosed at an advanced stage that are not eligible for curative therapy such as surgical resection, liver transplantation, radiofrequency ablation, and percutaneous ethanol injection. According to Barcellona Clinic Liver Cancer (BCLC) staging and treatment, standard treatment of advanced HCC is sorafenib. And there are some reports that hepatic arterial infusion chemotherapy (HAIC) could be a beneficial therapeutic option for patients with advanced HCC. We report a case of advanced HCC with portal vein thrombosis that received liver transplantation after combination treatment of HAIC and sorafenib.

Conus Medullaris Syndrome after Transcatheter Arterial Chemoembolization in Patient with Hepatocellular Carcinoma: Sun Hong Yoo, Si Hyun Bae, Pil Soo Sung, Hee Yeon Kim, Do Seon Song, Myeong Jun Song, Jong Young Choi, Seung Kew Yoon, Ho Jong Chun; Journal of the Korean Liver Cancer Study Group. 2011;11(2):185-189. Published online September 30, 2011

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Abstract PDF: Hepatocellular carcinoma (HCC) is the fourth most common cancer in Korea and a common cause of cancer death. Transcatheter arterial chemoembolization (TACE) is used as palliative therapy for patients with inoperable HCC. TACE is an effective treatments for inoperable HCC, but variable complications due to using embolic agents can occur after TACE. Complications due to embolic agents include pulmonary lipiodol embolism, splenic infarction, cerebral lipiodol infarction, and spinal cord injury. This is a rare case of spinal cord injury after a sixth TACE via right T9 intercostal artery.

A Case of Complete Remission in Hepatocellular Carcinoma by Metronomic Hepatic Artery Infusion Chemotherapy: Myeong Jon Song, CHung-Hwa Park, Si Hyun Bae, Jong Young Choi, Seung Kew Yoon, Ho Jong Chun; Journal of the Korean Liver Cancer Study Group. 2010;10(1):35-39. Published online June 30, 2010

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Abstract PDF: A 53-year-old man patient was admitted for evaluation of abdominal pain. Liver dynamic CT showed infiltrative type mass in right hepatic angle with arterial enhancement and rapid washout. Also low density tumor thrombus is filled with in right portal vein. He was diagnosed HCC (UICC stage IVa) with liver cirrhosis (Child-Pugh class B). With the sixth cycle of metronomic hepatic artery infusion chemotherapy for infiltrative mass, HCC showed no stain in hepatic angiography and tumor marker are normalized at seven month from initial diagnosis.

Early Intrahepatic Recurrence of Hepatocellular Carcinoma with Metastasis to Lung and Brain after Radiofrequency Ablation: Jin Dong Kim, Jung Hyun Kwon, Si Hyun Bae, Jong Young Choi, Seung Kew Yoon, Young Jun Lee, Sung Eun Rha, Ho Jong Chun, Byung Gil Choi, Hae Giu Lee; Journal of the Korean Liver Cancer Study Group. 2009;9(1):37-40. Published online June 30, 2009

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Abstract PDF: Radiofrequency ablation (RFA) is the preferred method of local ablation for patients with small (<3 cm sized) hepatocellular carcinoma (HCC) when surgical resection cannot be applied. If RFA procedure is sufficiently completed, it provides lower local tumor recurrence, and longer overall as well as disease-free survival. We experienced a case of early stage HCC which recurred at 2 months after successful RFA procedure, and rapidly metastasized to lung and brain.

Rapid recurrence following living donor liver transplantation for hepatocellular carcinoma within Milan criteria: Hyun Young Woo, Jin Dong Kim, Jung Hyun Kwon, Si Hyun Bae, Jong Young Choi, Seung Kew Yoon, Sung Eun Rha, Jae Young Byun, Ho Jong Chun, Byung Gil Choi, Hae Kyu Lee, Young Kyoung You, Dong Gu Kim; Journal of the Korean Liver Cancer Study Group. 2009;9(1):45-48. Published online June 30, 2009

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Abstract PDF: Liver transplantation is curative therapy for hepatocellular carcinoma especially if ,within Milan criteria, 4 year survival and recurrence-free survival was reported to be 85% and 92%, respectively. Herein we report a patient who experience rapid recurrence following living donor liver transplantation (LDLT) for hepatocellular carcinoma within Milan criteria. A 52 year-old-men patient with known liver cirrhosis associated with hepatitis B virus was admitted for the treatment of hepatocellular carcinoma (HCC). Abdominal CT revealed two nodules less than 3 cm in right hepatic lobe. After single session of transcatheter arterial chemoembolization (TACE), the patient underwent LDLT. After seven months following transplantation, recurrent HCC was detected on transplanted liver with concurrent metastatic nodule in lung. Although TACE and metastsectomy were performed for recurrent intrahepatic mass and lung metastasis, recurrent HCC showed rapid progression and patient died of progressive tumor after 10 months following LDLT.

Treatment of Massive Hepatocellular Carcinoma with Portal Vein Invasion: Jung Hyun Kwon, Jong Young Choi, Jin Dong Kim, Hyun Young Woo, Si Hyun Bae, Seung Kew Yoon, Young Jun Lee, Ho Jong Chun; Journal of the Korean Liver Cancer Study Group. 2009;9(1):53-58. Published online June 30, 2009

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Abstract PDF: A 52 year-old-man patient was admitted for evaluation of hepatic mass which was detected on screening ultrasonography. His abdominal CT showed a massive infiltrating mass in left hepatic lobe and another 2.4 cm nodule in S6 of Rt. Hepatic lobe with arterial enhancement and rapid wash out underlying liver cirrhosis. Also, low density tumor thrombus are filled in Lt. portal vein and extended into main portal vein. He was finally diagnosed HCC (UICC stage IVa) with liver cirrhosis (Child-Pugh class A) and hepatitis B. With the four times of trasnarterial chemo-lipiodolization and seven times of intraarterial infusion chemotherapy for huge mass and one time Radiofrequency ablation (RFA) for daughter nodule, his HCC showed no stain in hepatic angiogram at nine month from initial diagnosis. After additional eight times of intra-arterial infusion chemotherapy, new small nodule developed in S6 and was ablated with RFA. At eighteen months after initial diagnosis, he shows no viable lesion on the imaging study and tumor markers are normalized.

A Case of Advanced Hepatocellular Carcinoma in Twenties Treated by Multimodality Therapy: Jang Eun Lee, Na Ri Yoon, Si Hyun Bae, Jong Young Choi, Seung Kew Yoon, Dong Goo Kim, Ho Jong Chun, Byung Gil Choi, Hae Giu Lee, Hong Seok Jang, Chan Kwon Jung, Eun Sun Jang; Journal of the Korean Liver Cancer Study Group. 2009;9(1):82-85. Published online June 30, 2009

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Abstract PDF: The prognosis of young patients with hepatocellular carcinoma is remains controversial. Here we report a case of advanced hepatocellular carcinoma in twenty, successfully treated with transarterial chemolipidolization (TACL), systemic chemotherapy, radiation therapy and surgical resection. Previously healthy 28 years old woman was admitted for treatment of hepatocellular carcinoma. Abdominal CT showed a diffuse infiltrative HCC involving both lobes with intrahepatic bile duct invasion and pericardial lymphadenopathy. She was treated TAC with systemic chemotherapy and external beam radiotherapy. 6 months after these treatments, main tumor and the pericardial lymph node were decreased in size. And then extended left lobectomy and systemic chemotherapy were done. The pericardial lymph node was markedly decreased. The patient has been followed for 10 months without evidence of regional tumor recurrence.

A Case of Advanced Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis Achieving Complete Response with New Therapeutic Modalities: Hyun Young Woo, Jin Dong Kim, Jung Hyun Kwon, Chan Ran You, Jeong Won Jang, Si Hyun Bae, Jong Young Choi, Se Hyun Cho, Seung Kew Yoon, Dong Hoon Lee, Ho Jong Chun, Byung Gil Choi, Chul Seung Kay; Journal of the Korean Liver Cancer Study Group. 2008;8(1):124-127. Published online June 30, 2008

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Abstract PDF: A 45-year-old man was admitted for the treatment of hepatocellular carcinoma (HCC). He was diagnosed hepatitis B carrier 16 years ago and has not done a routine check. Abdominal CT showed a diffuse infiltrative HCC involving right hepatic lobe with portal vein tumor thrombosis (PVTT) involving right portal vein and proximal portion of left portal vein umbilical portion. With concurrent transcatheter arterial chemotherapy (TAC), helical tomotherapy for portal vein thrombosis was done. With these treatments, main tumor and PVTT was decreased in size markedly and no stain in hepatic angiogram. Due to repeated TAC, hepatic arterial stenosis occurred and TAC was stopped. 3 months after, recurrent tumor was detected in MRI. Radiofrequency ablation followed by High Intensity Focused Ultrasound (HIFU) was done for this recurrent mass. No viable mass was shown in the follow up MRI done 6 months after HIFU.

Combined hepatocellular and cholangiocarcinoma: Jung Hyun Kwon, Si Hyun Bae, Jung Pil Suh, Ho Sung Park, Chan Ran You, Jong Young Choi, Seung Kew Yoon, Dong Hoon Lee, Ho Jong Chun, Byung Gil Choi, Chan Kwon Chung, Eun Sun Jung, Mi Ryung Ryu; Journal of the Korean Liver Cancer Study Group. 2007;7(1):49-54. Published online June 30, 2007

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Abstract PDF: A 43 year-old-women patient was admitted for one month of jaundice. She was diagnosed hepatitis B carrier 17 years ago and has not done a routine check. Abdominal CT showed a large ill defined mass in left hepatic lobe with inhomogenous enhancement in arterial and delayed phase. The result of biopsy including the immunohistochemical stains showed the combined hepatocellular and cholangiocarcinoma (stage IVa, type C by Allen and Lisa). With the radiation therapy (3,910 cGy), six times of transarterial chemo-lipiodolization and two times of percutaneous ethanol injection, huge mass was markedly decreased in size and no stain in hepatic angiogram. She underwent left lobectomy.

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