Published online Jun 14, 2013. doi: 10.3748/wjg.v19.i22.3512
Revised: April 14, 2013
Accepted: April 18, 2013
Published online: June 14, 2013
This paper introduces an innovative treatment for extra-hepatic metastasis of hepatocellular carcinoma. A 71-year-old patient had a stable liver condition following treatment for hepatocellular carcinoma, but later developed symptomatic mediastinal metastasis. This rapidly growing mediastinal mass induced symptoms including cough and hoarseness. Serial sessions of transarterial embolization (TAE) successfully controlled this mediastinal mass with limited side effects. The patient’s survival time since the initial diagnosis of the mediastinal hepatocellular carcinoma was 32 mo, significantly longer than the 12 mo mean survival period of patients with similar diagnoses: metastatic hepatocellular carcinoma and a liver condition with a Child-Pugh class A score. Currently, oral sorafenib is the treatment of choice for metastatic hepatocellular carcinoma. Recent studies indicate that locoregional treatment of extra-hepatic metastasis of hepatocellular carcinomas might also significantly improve the prognosis in patients with their primary hepatic lesions under control. Many effective locoregional therapies for extrahepatic metastasis, including radiation and surgical resection, may provide palliative effects for hepatocellular carcinoma-associated mediastinal metastasis. This case report demonstrates that TAE of metastatic mediastinal hepatocellular carcinoma provided this patient with tumor control and increased survival time. This finding is important as it can potentially provide an alternative treatment option for patients with similar symptoms and diagnoses.
Core tip: This report presents a patient with metastatic hepatocellular carcinoma localized to his mediastinum. The metastatic tumor grew rapidly, with α-fetoprotein (AFP) elevation rates correlating with the size of the tumor and tumor growth. We used several sessions of transarterial embolization to control this metastatic tumor. After every successful intervention, the tumor had been stabilized and AFP levels were decreased significantly, resulting in a survival time of the patient that is much longer when compared to the mean survival times of others with similar diagnoses. Transarterial embolization could be an alternative treatment choice for patients with mediastinal metastasis of hepatocellular carcinoma.