A case of hepatocellular carcinoma with iliac metastasis achieving complete long-term remission by multidisciplinary therapy with radiation therapy, transcatheter arterial chemoembolization, and sorafenib

Abstract

A left iliac tumor was detected by magnetic resonance imaging in a 70-year-old man presenting with low back pain. He had accompanying hypertension but no drinking habit. Biopsy of the tumor revealed hepatocytepositive cancer cells, which suggested hepatocellular carcinoma (HCC) metastasis. Multiple HCC tumors present in both hepatic lobes as well as in the osteolytic left iliac bone tumor were enhanced in the early arterial phase and washed out in the delayed phase of computed tomography. Following radiation therapy for the pain due to iliac metastasis, four rounds of transcatheter arterial chemoembolization (TACE) were performed on the intrahepatic and iliac tumor regions. Sorafenib was commenced two months after the first TACE. He has remained in complete remission for approximately 4 years with 200 mg/day oral sorafenib. Based on these results, patients with progressed HCC in a favorable physical state due to appropriate pain control may be candidates for multidisciplinary therapy that includes sorafenib and TACE.