Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2024 Jun 6;12(16):2847-2855.
doi: 10.12998/wjcc.v12.i16.2847.

Conversion therapy of a giant hepatocellular carcinoma with portal vein thrombus and inferior vena cava thrombus: A case report and review of literature

Wen-Jie Song  1 , Jian Xu  1 , Ye Nie  1 , Wei-Min Li  1 , Jian-Ping Li  2 , Li Yang  3 , Meng-Qi Wei  4 , Kai-Shan Tao  5
Affiliations
Case Reports

Conversion therapy of a giant hepatocellular carcinoma with portal vein thrombus and inferior vena cava thrombus: A case report and review of literature

Wen-Jie Song et al. World J Clin Cases. .

Abstract

Background: The prognosis of hepatocellular carcinoma (HCC) combined with portal and hepatic vein cancerous thrombosis is poor, for unresectable patients the combination of targeted therapy and immune therapy was the first-line recommended treatment for advanced HCC, with a median survival time of only about 2.7-6 months. In this case report, we present the case of a patient with portal and hepatic vein cancerous thrombosis who achieved pathologic complete response after conversion therapy.

Case summary: In our center, a patient with giant HCC combined with portal vein tumor thrombus and hepatic vein tumor thrombus was treated with transcatheter arterial chemoembolization (TACE), radiotherapy, targeted therapy and immunotherapy, and was continuously given icaritin soft capsules for oral regulation. After 7 months of conversion therapy, the patient's tumor shrank and the tumor thrombus subsided significantly. The pathology of surgical resection was in complete remission, and there was no progression in the postoperative follow-up for 7 months, which provided a basis for the future strategy of combined conversion therapy.

Conclusion: In this case, atezolizumab, bevacizumab, icaritin soft capsules combined with radiotherapy and TACE had a good effect. For patients with hepatocellular carcinoma combined with hepatic vein/inferior vena cava tumor thrombus, adopting a high-intensity, multimodal proactive strategy under the guidance of multidisciplinary team (MDT) is an important attempt to break through the current treatment dilemma.

Keywords: Case report; Conversion; Downstaging; Hepatocellular carcinoma; Icaritin; Portal vein thrombus.

PubMed Disclaimer

Conflict of interest statement

Conflict-of-interest statement: All authors have no conflict of interest.

Figures

Figure 1
Figure 1
Radiological assessment of primary nodule at diagnosis. A: Primary tumor; B: Portal vein tumor thrombus; C: Inferior vena cava thrombosis.
Figure 2
Figure 2
Protein induced by vitamin K absence or antagonist-II and alpha fetoprotein level during treatment. PIVKA-II: Protein induced by vitamin K absence or antagonist-II; AFP: Alpha fetoprotein.
Figure 3
Figure 3
Tumor changes during treatment. A: April 24, 2022; B: July 28, 2022; C: September 15, 2022; D: November 16, 2022.
Figure 4
Figure 4
Tumour tissue removed by surgery.
Figure 5
Figure 5
Radiological assessment after surgery. A: Abdominal computed tomography (CT); B: Abdominal CT.
Figure 6
Figure 6
Treatment profile. TACE: Transcatheter arterial chemoembolization.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Pawarode A, Voravud N, Sriuranpong V, Kullavanijaya P, Patt YZ. Natural history of untreated primary hepatocellular carcinoma: A retrospective study of 157 patients. Am J Clin Oncol. 1998;21:386–391. - PubMed
    1. Chinese Society of Liver Cancer Chinese Medical Doctor Association. [Chinese expert consensus on multidisciplinary diagnosis and treatment of hepatocellular carcinoma with portal vein tumor thrombus] Linchuang Gandanbing Zazhi. 2019;35:737–743.
    1. [Chinese expert consensus on multidisciplinary diagnosis and treatment of hepatocellular carcinoma with hepatic vein or inferior vena cave tumor thrombus] Zhongguo Shiyong Waike Zazhi. 2019;6:17–22.
    1. Finn RS, Qin S, Ikeda M, Galle PR, Ducreux M, Kim TY, Kudo M, Breder V, Merle P, Kaseb AO, Li D, Verret W, Xu DZ, Hernandez S, Liu J, Huang C, Mulla S, Wang Y, Lim HY, Zhu AX, Cheng AL IMbrave150 Investigators. Atezolizumab plus Bevacizumab in Unresectable Hepatocellular Carcinoma. N Engl J Med. 2020;382:1894–1905. - PubMed
    1. Yamamura K, Beppu T, Miyata T, Okabe H, Nitta H, Imai K, Hayashi H, Akahoshi S. Conversion Surgery for Hepatocellular Carcinoma Following Molecular Therapy. Anticancer Res. 2022;42:35–44. - PubMed

Publication types