A case report of hepatocellular carcinoma with bone metastasis successfully treated with assertive combination therapy

Abstract

A 65-year-old man who had been followed up after diagnosis of hepatitis B visited a hospital because of fever elevation. He was introduced to our hospital and was admitted to our department suffering from hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). Tumor markers were elevated (α-fetoprotein (AFP), 142 ng/ml; des-γ-carboxy prothrombin (DCP), 32038 AU/ι), and computed tomography (CT) revealed a large tumor occupying the right lobe of the liver with PVTT occupying the right portal vein to the neck of the left portal vein Operative diagnosis was HCC (H2, MT-P A multiple, infiltrative type, Ig FC (-), Fc-inf (-), Sf (-), S0, Vp4, Vv0, Va0, B0, P0) T4N0M0 Stage IVA, and extended right hepatectomy and thrombectomy were performed. He complained of left lumbar pain after the operation and was followed up at the orthopedic department, but his lumbar pain persisted and tumor marker elevation continued Whole body CT revealed only a large left iliac tumor without liver or lung metastasis The iliac tumor was treated by radiation therapy with transarterial 5-FU infusion and transarterial chemoembolization. Tumor markers normalized soon after treatment, and 17 months after completion of treatment, CT revealed regeneration of the ilium without bone tumor and no liver or lung metastasis. There is no established treatment for extrahepatic metastasis of HCC, and treatment is limited to radiation for pain control in many patients with bone metastasis. In HCC patients with well-controlled liver condition, assertive combination therapy for distant metastasis is expected to improve the prognosis. © 2010 The Japan Society of Hepatology.