内容紹介
Summary
Case: A 76-year-old man was referred to our hospital for advanced hepatocellular carcinoma(HCC)with chronic hepatitis type B. Although he underwent right anterior sectionectomy and S3 segmentectomy, multiple recurrences were found in the hepatic remnant after 2 months. Transcatheter arterial chemoembolization(TACE)and transcatheter arterial infusion(TAI)were performed separately. One and a half month after the last TAI, AFP and PIVKA-Ⅱ levels markedly elevated, and multiple early enhancing nodules with portal vein tumor thrombosis were detected on CT. A half dose of sorafenib(400 mg/day)was administered to the patient who was refractory to TACE. Sorafenib was discontinued after 4 weeks because the patient developed general fatigue and anorexia(Grade 3). Furthermore, these adverse events became worse, and ascites appeared. He was hospitalized in the palliative care unit for best supportive care for 3 weeks and also received outpatient treatment for more than 14 months. Fifteen months after discontinuing sorafenib administration, his condition improved dramatically, and CT revealed that the multiple HCC had reduced in size. Moreover, the portal vein tumor thrombosis disappeared. As his performance status and liver function were well preserved, he underwent partial hepatectomy for residual HCC. The patient remains alive without recurrence at 18 months, despite no administration of sorafenib. Conclusion: This case demonstrates that sorafenib administration combined with surgical treatment could possibly cure advanced HCC refractory to TACE.
要旨
症例は76歳,男性。初発肝細胞癌(HCC)に対し2015年10月肝前区域切除,S3部分切除を施行した。術後2か月目に肝S4,S6にHCCを認め,肝動脈塞栓療法(TACE)を施行するも,1か月後に肝外側区域にHCCを認め,肝動注療法(TAI)を施行した。TAI 1か月半後に腫瘍マーカーの著明な上昇(AFP 16,710 ng/mL)と門脈腫瘍栓を伴う多発HCCを認め,TACE不応と判断した。2016年6月sorafenibの投与を開始した。内服4週目にGrade 3の全身倦怠感,食思不振を認め休薬したが,その後腹水が出現し,全身状態は悪化した。積極的な治療は困難と考え,緩和治療となった。sorafenib休薬15か月後,全身状態の改善がみられCTを施行したところ腫瘍は著明に縮小し,腫瘍数も減少,門脈腫瘍栓も消失していた。遠隔転移も認めず,全身状態も保たれていることから肝部分切除を施行した。肝切除術18か月後の現在も病勢制御が得られている。
目次
Case: A 76-year-old man was referred to our hospital for advanced hepatocellular carcinoma(HCC)with chronic hepatitis type B. Although he underwent right anterior sectionectomy and S3 segmentectomy, multiple recurrences were found in the hepatic remnant after 2 months. Transcatheter arterial chemoembolization(TACE)and transcatheter arterial infusion(TAI)were performed separately. One and a half month after the last TAI, AFP and PIVKA-Ⅱ levels markedly elevated, and multiple early enhancing nodules with portal vein tumor thrombosis were detected on CT. A half dose of sorafenib(400 mg/day)was administered to the patient who was refractory to TACE. Sorafenib was discontinued after 4 weeks because the patient developed general fatigue and anorexia(Grade 3). Furthermore, these adverse events became worse, and ascites appeared. He was hospitalized in the palliative care unit for best supportive care for 3 weeks and also received outpatient treatment for more than 14 months. Fifteen months after discontinuing sorafenib administration, his condition improved dramatically, and CT revealed that the multiple HCC had reduced in size. Moreover, the portal vein tumor thrombosis disappeared. As his performance status and liver function were well preserved, he underwent partial hepatectomy for residual HCC. The patient remains alive without recurrence at 18 months, despite no administration of sorafenib. Conclusion: This case demonstrates that sorafenib administration combined with surgical treatment could possibly cure advanced HCC refractory to TACE.
要旨
症例は76歳,男性。初発肝細胞癌(HCC)に対し2015年10月肝前区域切除,S3部分切除を施行した。術後2か月目に肝S4,S6にHCCを認め,肝動脈塞栓療法(TACE)を施行するも,1か月後に肝外側区域にHCCを認め,肝動注療法(TAI)を施行した。TAI 1か月半後に腫瘍マーカーの著明な上昇(AFP 16,710 ng/mL)と門脈腫瘍栓を伴う多発HCCを認め,TACE不応と判断した。2016年6月sorafenibの投与を開始した。内服4週目にGrade 3の全身倦怠感,食思不振を認め休薬したが,その後腹水が出現し,全身状態は悪化した。積極的な治療は困難と考え,緩和治療となった。sorafenib休薬15か月後,全身状態の改善がみられCTを施行したところ腫瘍は著明に縮小し,腫瘍数も減少,門脈腫瘍栓も消失していた。遠隔転移も認めず,全身状態も保たれていることから肝部分切除を施行した。肝切除術18か月後の現在も病勢制御が得られている。