TRANSARTERIAL CHEMOEMBOLIZATION FOR THE TREATMENT OF HEPATOCELLULAR CARCINOMA - CASE REPORT
Keywords:
Hepatocellular carcinoma (HCC), Transarterial chemoebmolization (TACE), Abdominal ultrasound, Abdominal computer tomography (CT)Abstract
Hepatocellular carcinoma (HCC) is a primary tumor of the liver and constitutes more than 90% of the
primary tumor of the liver. Hepatocellular carcinoma occurs in approximately 85% of patients diagnosed with
cirrhosis. HCC is now the fifth most common cause of cancer worldwide. The second leading cause of cancer death
after lung cancer in men is HCC. Five-year survival of HCC is 18% and second to pancreatic cancer. Significant risk
factors for hepatocellular carcinoma include viral hepatitis (hepatitis B and hepatitis C), alcoholic liver disease, and
non-alcoholic liver steatohepatitis/non-alcoholic fatty liver disease.The annual incidence of HCC in patients with
cirrhosis is 2-4%.
The detection is usually late, with limited possibilities for surgical treatment and it is resistant to chemotherapy.
Other therapeutic possibilities include transarterial embolization (TACE), which was carried out in this patients’
case report. Material and methods: Treatment of a 61-year-old female patient, with initial symptoms such as fatigue,
overal weakness, nothing else specific. From the laboratory analyses, were noticed elevated: tumor marker AFP
,hepatal viral marker for HBV (HbsAg+) and erythrocyte sedimentation rate (ESR), and lower parameters for:
albumin, platelet and hemoglobin. From the performed ultrasound examination and CT of the abdomen,focal change
was seen in the right lobe of the liver segment 6 with dimensions 40*50mm. Additionally it was done "Tru cut
core" biopsy of the focal change in the liver with histopathology finding: “Clear cell type” of hepatocellular
carcinoma. Successively in the therapy, were performed three seances of transarterial hemembolization (TACE)
with Doxorubicin and "life pearl" particles 100+25 microns, and then with 150 and 500 microns. In the last imaging
CT of the abdomen, it was seen a focal hypodense change in the right lobe of the liver (segment 6) with dimensions
40*50mm with complete devascularization, without any reccurence.
References
Asafo-Agyei, K. O., & Samant, H. (2022). Hepatocellular Carcinoma. In StatPearls. StatPearls Publishing.Ioannou, G. N., Green, P., Kerr, K. F., & Berry, K. (2019). Models estimating risk of hepatocellular carcinoma in patients with alcohol or NAFLD-related cirrhosis for risk stratification. Journal of hepatology, 71(3), 523–533. https://doi.org/10.1016/j.jhep.2019.05.008
Balogh, J., Victor, D., 3rd, Asham, E. H., Burroughs, S. G., Boktour, M., Saharia, A., Li, X., Ghobrial, R. M., & Monsour, H. P., Jr (2016). Hepatocellular carcinoma: a review. Journal of hepatocellular carcinoma, 3, 41–53. https://doi.org/10.2147/JHC.S61146
BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update. Journal of hepatology, 76(3), 681–693. https://doi.org/10.1016/j.jhep.2021.11.018
Biolato, M., Marrone, G., Racco, S., Di Stasi, C., Miele, L., Gasbarrini, G., Landolfi, R., & Grieco, A. (2010). Transarterial chemoembolization (TACE) for unresectable HCC: a new life begins?. European review for medical and pharmacological sciences, 14(4), 356–362.
Gao, S., Yang, Z., Zheng, Z., Yao, J., Deng, M., Xie, H., Zheng, S., & Zhou, L. (2013). Doxorubicin-eluting bead versus conventional TACE for unresectable hepatocellular carcinoma: a meta-analysis. Hepato-gastroenterology, 60(124), 813–820. https://doi.org/10.5754/hge121025
Han, K., & Kim, J. H. (2015). Transarterial chemoembolization in hepatocellular carcinoma treatment: Barcelona clinic liver cancer staging system. World journal of gastroenterology, 21(36), 10327–10335. https://doi.org/10.3748/wjg.v21.i36.10327
Müller L, Stoehr F, Mähringer-Kunz A, Hahn F, Weinmann A, Kloeckner R. Current Strategies to Identify Patients That Will Benefit from TACE Treatment and Future Directions a Practical Step-by-Step Guide. J Hepatocell Carcinoma. 2021;8:403-419 https://doi.org/10.2147/JHC.S285735
Reig, M., Forner, A., Rimola, J., Ferrer-Fàbrega, J., Burrel, M., Garcia-Criado, Á., Kelley, R. K., Galle, P. R., Mazzaferro, V., Salem, R., Sangro, B., Singal, A. G., Vogel, A., Fuster, J., Ayuso, C., & Bruix, J. (2022).
Sangro, B., & Salem, R. (2014). Transarterial chemoembolization and radioembolization. Seminars in liver disease, 34(4), 435–443. https://doi.org/10.1055/s-0034-1394142
Sidali, S., Trépo, E., Sutter, O., & Nault, J. C. (2022). New concepts in the treatment of hepatocellular carcinoma. United European gastroenterology journal, 10(7), 765–774. https://doi.org/10.1002/ueg2.12286
