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KMID : 1039320140140010046
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Journal of Liver Cancer
2014 Volume.14 No. 1 p.46 ~ p.52
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A Case of Perforation of Gastric Ulcer after Complete Remission of Huge Hepatocellular Carcinoma Invading Main Portal Vein with Combination Therapy of Stereotactic Body Radiation Therapy and Sorafenib
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Hwang Sang-Youn
Lee Seon-Mi
Im Jung-Woo
Kim Joon-Suk
Ahn Sang-Bu
Ji Eun-Kyeong
Choi Chul-Won
Yang Kwang-Mo
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Abstract
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Hepatocellular carcinoma (HCC) patients with main portal vein invasion have a poor prognosis associated with a median survival time of 2.7 months. Though many guidelines recommended sorafenib in HCC patients with macrovascular invasion (MVI), many clinicians or centers still select locoregional therapy (LRT) such as transarterial chemoembolization (TACE), radiation therapy (RT), or combination with LRT and sorafenib because the survival improvement by sorafenib only is expected to be shorter than that without MVI. However this multidisciplinary approach may increase treatment related toxicity such as liver failure etc. Stereotactic body radiation therapy (SBRT) is new technology providing very highly conformal ablative radiation dose for a small numbers (3-5 fractions) of large fraction size and is expected to new effective modality for HCC with MVI. Based on above suggestions, we herein offer our experience of a patient with perforation of radiation induced gastric ulcer after complete remission of tumor and main portal vein thrombosis by combination therapy of SBRT and sorafenib. Further study, maybe regarding a combination of locoregional and systemic therapy, is necessary on how to manage HCC patients with main portal vein invasion.
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KEYWORD
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Hepatocellular carcinoma, Portal vein invasion, Stereotactic body radiotherapy, Sorafenib, Gastric ulcer perforation
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