RESUMEN
The prognosis of HCC with vascular invasion is dismal, but surgery is elected when the hepatic reserve is adequate. The case involved a 68-year-old male HCV carrier. A 10 cm diameter tumor occupying the central 2 segments of the liver and liver metastasis in the left lobe were detected. The patient was diagnosed with multiple HCC with severe vascular invasion of Vp2 and Vv3. The tumor shrunk dramatically after starting HAIC therapy with cisplatin and oral administration of sorafenib. A laparoscopic partial hepatectomy was performed for the viable lesion. The tumor showed almost complete coagulative necrosis. Multiple hepatic metastases were found 4 months after surgery, but the tumor was under control at 25 months after the first HAIC due to HAIC, oral administration of sorafenib, and RFA. An improved prognosis for multiple HCC with severe vascular invasion can be expected by performing multidisciplinary treatments including surgery.
Asunto(s)
Carcinoma Hepatocelular/terapia , Neoplasias Hepáticas/terapia , Anciano , Antineoplásicos/uso terapéutico , Ablación por Catéter , Cisplatino/administración & dosificación , Terapia Combinada , Hepatectomía , Humanos , Infusiones Intraarteriales , Neoplasias Hepáticas/patología , Masculino , Invasividad Neoplásica , Niacinamida/análogos & derivados , Niacinamida/uso terapéutico , Compuestos de Fenilurea/uso terapéutico , Vena Porta , Pronóstico , SorafenibRESUMEN
The patient was a 73-year-old man who complained of dysphagea. Various examinations revealed an esophageal cancer with direct invasion to the left main bronchus (cT4, N2 (104R, 106recR), M0, Stage IVa) and gastric cancer (cT2, N0, M0, Stage IB). The patient was given preoperative chemoradiotherapy (40 Gy/20 fr with CDGP 10 mg/body day 1-5, 8- 12, 15-19 and 5-FU 250 mg/body day 1-5, 8-12, 15-19). After the chemoradiotherapy, we estimated that the esophageal cancer was down stage (cT4-->T3), and that a curative operation was possible. Therefore, subtotal esophagectomy and partial gastrectomy were performed without a complication. Pathological therapeutic evaluation of the esophageal cancer was complete response (CR) and the gastric cancer was T2, N0. Adjuvant chemotherapy was undergone with S-1. However, two years after the first operation, we found a recurrence of gastric duct. Therefore a surgical resection for recurrence of gastric duct was performed. The patient is still alive without recurrence 5 years and 2 months after the first treatment. Radiation therapy combined with nedaplatin and 5-FU is a safe and effective method for treating cT4 advanced esophageal cancer.