Early experience of transarterial chemoembolization and stereotactic body radiotherapy as neoadjuvant therapy in treating solitary right-lobe hepatocellular carcinoma greater than 10cm

Abstract

For good liver reserve patients with large (≥10cm) right-lobe solitary hepatocellular carcinoma (HCC), resection is technically difficult. Moreover, inadequate future liver remnant volume might preclude major surgical resection. In this case series, we report our early experience in managing a group of such patients using transarterial chemoembolization (TACE) and stereotactic body radiotherapy (SBRT) as a downstaging neoadjuvant therapy before resection. From July 2012 to November 2013, we treated five patients with large right-lobe, solitary HCC (10-24cm) by this regime. Portal vein thrombosis was seen in two cases. The tumour showed significant reduction in size, and the left lobe showed significant enlargement. All tumours were successfully resected. Technical difficulty due to post-TACE and -SBRT fibrosis and adhesion can be overcome by using the anterior approach and hanging technique with mild modification. There was one mortality reported in this series, but a post-mortem study showed acute myocardial infarction without any surgical complications. Radiation-induced myocardial injury was also excluded. TACE and SBRT are a safe option to downstage large, right-lobe solitary HCC greater than 10cm, with or without portal vein thrombosis. Surgical resection after this neoadjuvant therapy can be carried out safely with some modification of technique.