Published online Jan 27, 2019. doi: 10.4254/wjh.v11.i1.119
Peer-review started: August 28, 2018
First decision: October 15, 2018
Revised: November 30, 2018
Accepted: December 12, 2018
Article in press: December 12, 2018
Published online: January 27, 2019
Hepatocellular carcinoma (HCC) is the second most lethal malignancy worldwide. There has been virtually no change in the survivability of HCC in spite of improvement in therapies. Surgery is considered the ideal first, curative intervention, however most patients present in advanced stages with unresectable disease. Therefore, systemic and liver-directed non-operative therapies are initially offered to downstage the disease. To ensure optimal management, a multidisciplinary team approach is often warranted. Our case highlights the benefits of a multidisciplinary approach in a young woman with multifocal, bilobar HCC.
A 36-year-old Chinese woman with untreated hepatitis B was found to have large bilobar HCC during work up for abdominal pain. Her initial serum alpha-fetoprotein was significantly elevated to 311136 ng/mL. Computed tomography scan demonstrated bulky bilobar liver masses, consistent with intermediate stage HCC, Barcelona Clinic Liver Cancer Stage B. Her case was discussed and a personalized care plan was developed at the Multidisciplinary Center for Advanced Minimally Invasive Liver Oncologic Therapies at the University of Washington. She initially underwent bilobar transarterial chemoembolization with partial response of the left lobar tumor. Salvage hypofractionated proton beam radiation therapy was delivered to the right lobe followed by two additional transarterial chemoembolizations to the left lobe with good response. Finally, to remove left lobar residual disease, she was taken to the operating room for a left hepatectomy eleven months after her initial presentation. She continues to be without evidence of disease.
Coordinating the multiple HCC treatment modalities is complex and our case highlights the benefits of a multidisciplinary approach.
Core tip: Hepatocellular carcinoma is a challenging disease that requires a personalized and multidisciplinary approach for treatment. Our case highlights a favorable patient outcome in a young woman with multifocal bilobar hepatocellular carcinoma as a result of a coordinated multimodal treatment approach utilizing catheter-based ablative techniques, external beam radiation therapy, and surgical resection.