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Research ArticleClinical Studies

A Huge Hepatocellular Carcinoma With Major Arteriovenous Shunt Successfully Treated With Chemoembolization Plus Lenvatinib Therapy Followed by Radiotherapy

TOSHIRO MASUDA, TORU BEPPU, HIDEAKI MIYAMOTO, YASUNORI NAGAYAMA, YOSHIYUKI FUKUGAWA, TOSHIHIKO MOTOHARA, YUKI ADACHI, ERI ODA, RYUICHI KARASHIMA, KAZUAKI YOSHIZATO and TAKATOSHI ISHIKO
Anticancer Research April 2025, 45 (4) 1785-1792; DOI: https://doi.org/10.21873/anticanres.17558
TOSHIRO MASUDA
1Department of Surgery, Yamaga City Medical Center, Yamaga, Japan;
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TORU BEPPU
1Department of Surgery, Yamaga City Medical Center, Yamaga, Japan;
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  • For correspondence: tbeppu@yamaga-mc.jp
HIDEAKI MIYAMOTO
2Department of Medical Oncology, Yamaga City Medical Center, Yamaga, Japan;
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YASUNORI NAGAYAMA
3Department of Radiology, Yamaga City Medical Center, Yamaga, Japan;
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YOSHIYUKI FUKUGAWA
4Department of Radiation Oncology, Graduate School of Life Science, Kumamoto University, Kumamoto, Japan;
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TOSHIHIKO MOTOHARA
5Department of Gastroenterology, Yamaga City Medical Center, Yamaga, Japan;
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YUKI ADACHI
1Department of Surgery, Yamaga City Medical Center, Yamaga, Japan;
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ERI ODA
1Department of Surgery, Yamaga City Medical Center, Yamaga, Japan;
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RYUICHI KARASHIMA
1Department of Surgery, Yamaga City Medical Center, Yamaga, Japan;
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KAZUAKI YOSHIZATO
6Yoshizato Clinic, Yamaga, Japan
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TAKATOSHI ISHIKO
1Department of Surgery, Yamaga City Medical Center, Yamaga, Japan;
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Abstract

Background/Aim: Large hepatocellular carcinoma (HCC) (defined as ≥10 cm) is associated with a poor prognosis in both resectable and unresectable patients. Liver resection and multidisciplinary treatment are recommended for solitary huge and multiple huge HCCs, respectively.

Case Report: The patient presented with a hypervascular HCC measuring over 10 cm in the right liver lobe and a suspected hypovascular tumor in the medial segment. He had nonB-nonC hepatitis with metabolic disease together with untreated 3-vessel coronary artery disease. Transarterial chemoembolization (TACE) and lenvatinib treatment were performed in parallel with coronary stent treatment. The treatment for HCC was effective, with the tumor’s contrast enhancement almost completely disappearing and the protein induced by the absence of vitamin K or antagonist-II level decreasing from 91,616 mAU/ml to 152 mAU/ml. After portal vein embolization, the tumor became resectable; however, the patient did not consent to a major hepatectomy. Only contrast-enhanced ultrasonography showed viable tumor tissue near the hepatic hilar Glissonean capsule. These tumors were contraindicated for thermal ablation; therefore, intensity-modulated radiation therapy (30 Gy/10 fractions) was performed. Percutaneous microwave ablation was successfully applied to another growing HCC in the medial segment. Three years after the initial treatment, the patient remains well and free of disease.

Conclusion: For patients who are contraindicative for immune checkpoint inhibitors or major liver resection, TACE plus lenvatinib followed by radiotherapy is safe and potentially an optimal treatment option.

Keywords:
  • Large hepatocellular carcinoma
  • arteriovenous shunt
  • chemoembolization
  • lenvatinib therapy
  • radiotherapy
  • Received February 24, 2025.
  • Revision received March 6, 2025.
  • Accepted March 7, 2025.
  • Copyright © 2025 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.
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Anticancer Research: 45 (4)
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A Huge Hepatocellular Carcinoma With Major Arteriovenous Shunt Successfully Treated With Chemoembolization Plus Lenvatinib Therapy Followed by Radiotherapy
TOSHIRO MASUDA, TORU BEPPU, HIDEAKI MIYAMOTO, YASUNORI NAGAYAMA, YOSHIYUKI FUKUGAWA, TOSHIHIKO MOTOHARA, YUKI ADACHI, ERI ODA, RYUICHI KARASHIMA, KAZUAKI YOSHIZATO, TAKATOSHI ISHIKO
Anticancer Research Apr 2025, 45 (4) 1785-1792; DOI: 10.21873/anticanres.17558

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A Huge Hepatocellular Carcinoma With Major Arteriovenous Shunt Successfully Treated With Chemoembolization Plus Lenvatinib Therapy Followed by Radiotherapy
TOSHIRO MASUDA, TORU BEPPU, HIDEAKI MIYAMOTO, YASUNORI NAGAYAMA, YOSHIYUKI FUKUGAWA, TOSHIHIKO MOTOHARA, YUKI ADACHI, ERI ODA, RYUICHI KARASHIMA, KAZUAKI YOSHIZATO, TAKATOSHI ISHIKO
Anticancer Research Apr 2025, 45 (4) 1785-1792; DOI: 10.21873/anticanres.17558
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Keywords

  • Large hepatocellular carcinoma
  • arteriovenous shunt
  • chemoembolization
  • lenvatinib therapy
  • radiotherapy
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