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KMID : 0361120230370010069
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Korean Journal of Transplantation
2023 Volume.37 No. 1 p.69 ~ p.75
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Posttransplant sequential adrenal and spine metastasis of hepatocellular carcinoma responsive to combined regorafenib and radiotherapy: a case report
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Kim Jae-Yoon
Yi Nam-Joon
Kim Yoon-Jun
Tony El Jabbour
Kim Ji-Young
Choi Hyun-Hwa
Lee Jae-Won
Lee Sol-A
Hong Su-Young
Lee Jeong-Moo
Hong Suk-Kyun
Choi Young-Rok
Lee Kwang-Woong
Suh Kyung-Suk
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Abstract
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Adrenal and spinal metastases of hepatocellular carcinoma (HCC) are rare entities with significant morbidity and mortality, particularly after liver transplantation (LT). We report a case of a 49-year-old man who underwent LT for hepatitis B-related end-stage liver disease and HCC (single 4.5 cm lesion [T1N0], without vascular invasion) in 2016. Eighteen months later, adrenal metastasis and hepatitis B seropositive conversion were developed with normal serum tumor. Adrenal metastasis was treated with radiation therapy (RT) and hepatitis B showed spontaneous seronegative conversion. However, 35 months later, spinal metastasis occurred with elevation of the protein induced by vitamin K absence or antagonist-II (PIVKA-II) level (197 mAU/mL), along with hepatitis B seropositive conversion. After sorafenib, sequential regorafenib with RT led to partial response of the spinal lesions, along with hepatitis B seronegative conversion and normal PIVKA-II levels. After 9 months of regorafenib combined with RT, two recurrent lesions were found, as well as hepatitis B seropositive conversion and lesions were treated with transarterial chemoembolization. The patient survived for more than 71 months after LT and 53 months after recurrence under various combinations of therapy. Combined systemic and locoregional therapies can be a treatment option for HCC recurrence, even in LT patients.
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KEYWORD
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Regorafenib, Radiotherapy, Sorafenib, Mortality, Case reports
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