内容紹介
Successful Multimodal Treatment for Aggressive Extrahepatic Metastatic Hepatocellular Carcinoma―A Case Report
Summary
A 38-year-old man underwent right hepatectomy for a huge hepatocellular carcinoma(HCC)in the right hepatic lobe. Four months later, recurrent and metastatic disease were observed in the remnant liver and right lung, respectively. We performed a hepatectomy for the recurrent lesion because transcatheter arterial chemoembolization(TACE)was not effective. After surgery, we initiated sorafenib treatment for the lung metastases. One year later, the lung metastases worsened and metastases were observed in the mediastinal lymph nodes, and both metastatic lesions were resected. Seven months later, para-aortic lymph nodal metastasis was observed and dissected. Three months later, metastasis to the supraclavicular lymph node was observed. We performed particle radiation therapy and a complete response was achieved. One year later, metastases in both lungs were observed and resected. Despite continued sorafenib administration throughout the clinical course, a metastasis to the left adrenal gland was observed. This lesion was extirpated because no other recurrent lesions were detected. At 4 years and 6 months after the first operation, no other recurrences have occurred. Currently, sorafenib is the initial drug of choice for HCC with extrahepatic metastases. It is possible to improve the prognosis of patients with HCC and extrahepatic metastases by applying surgical treatment during the course of sorafenib administration.
要旨
症例は38歳,男性。肝右葉を占拠する巨大肝細胞癌(HCC)の診断にて肝右葉切除術を施行。術後4か月で残肝再発および右肺転移を認めた。肝内再発が肝動脈化学塞栓術(TACE)不応であったため肝切除を行い,その後ソラフェニブを開始。1年後に肺転移巣の増悪および縦隔リンパ節転移を認めたため,これらを切除した。その7か月後に腹腔内傍大動脈リンパ節転移を認め,摘出。さらに3か月後には右鎖骨上窩リンパ節転移を認めたが,粒子線治療により完全寛解を得た。その1年後には両肺に1か所ずつ転移巣が出現したため,再度病変を切除。さらに6か月後に左副腎転移を認め,摘出。現在,初回手術より4年6か月経過したが,明らかな再発なく経過している。肝外転移巣の治療はソラフェニブが第一選択であるが,本症例のように積極的に外科的切除を追加することで長期生存を得る可能性が示唆された。
目次
Summary
A 38-year-old man underwent right hepatectomy for a huge hepatocellular carcinoma(HCC)in the right hepatic lobe. Four months later, recurrent and metastatic disease were observed in the remnant liver and right lung, respectively. We performed a hepatectomy for the recurrent lesion because transcatheter arterial chemoembolization(TACE)was not effective. After surgery, we initiated sorafenib treatment for the lung metastases. One year later, the lung metastases worsened and metastases were observed in the mediastinal lymph nodes, and both metastatic lesions were resected. Seven months later, para-aortic lymph nodal metastasis was observed and dissected. Three months later, metastasis to the supraclavicular lymph node was observed. We performed particle radiation therapy and a complete response was achieved. One year later, metastases in both lungs were observed and resected. Despite continued sorafenib administration throughout the clinical course, a metastasis to the left adrenal gland was observed. This lesion was extirpated because no other recurrent lesions were detected. At 4 years and 6 months after the first operation, no other recurrences have occurred. Currently, sorafenib is the initial drug of choice for HCC with extrahepatic metastases. It is possible to improve the prognosis of patients with HCC and extrahepatic metastases by applying surgical treatment during the course of sorafenib administration.
要旨
症例は38歳,男性。肝右葉を占拠する巨大肝細胞癌(HCC)の診断にて肝右葉切除術を施行。術後4か月で残肝再発および右肺転移を認めた。肝内再発が肝動脈化学塞栓術(TACE)不応であったため肝切除を行い,その後ソラフェニブを開始。1年後に肺転移巣の増悪および縦隔リンパ節転移を認めたため,これらを切除した。その7か月後に腹腔内傍大動脈リンパ節転移を認め,摘出。さらに3か月後には右鎖骨上窩リンパ節転移を認めたが,粒子線治療により完全寛解を得た。その1年後には両肺に1か所ずつ転移巣が出現したため,再度病変を切除。さらに6か月後に左副腎転移を認め,摘出。現在,初回手術より4年6か月経過したが,明らかな再発なく経過している。肝外転移巣の治療はソラフェニブが第一選択であるが,本症例のように積極的に外科的切除を追加することで長期生存を得る可能性が示唆された。