Spontaneous Regression Of Hepatocellular Carcinoma In A Pure Palliative Care Setting
Yamamoto, N., Yamamoto, C., & Tajitsu, T. (2022). Spontaneous regression of hepatocellular carcinoma in a pure palliative care setting. Journal of general and family medicine, 24(2), 126–128. https://doi.org/10.1002/jgf2.588
View Original Source →Abstract
We report a case of spontaneous remission of hepatocellular carcinoma in an 84-year-old woman who was managed in our best supportive care clinic. The tumor, once relapsed regardless of the application of conventional transcatheter arterial chemoembolization and radiofrequency ablation, regressed spontaneously within 4 months. The presence of an occlusive thrombus in the portal vein feeding to the site of the tumor suggests that the reduced blood supply might have caused tumor necrosis. Furthermore, the successful eradication of hepatitis C virus maintained performance status, and good nutrition might play other roles on it.
Case Details
Disease Location
Liver
Personal Characteristics
84-year-old native japanese woman. She had been diagnosed with HCV-related liver cirrhosis
Clinical Characteristics
A tumor 30 mm in diameter in segment 3 (s3) and a tumor 10 mm in diameter in s8 developed as a complication of liver cirrhosis, 9 years after the diagnosis of cirrhosis. She was treated with conventional transcatheter arterial chemoembolization (c-tace) of the tumor in s3, 2 years later. After 1 year, the tumor in s8 was treated with radiofrequency ablation (rfa). Ledipasvir 90 mg and sofosbuvir 400 mg were administered for 12 weeks in parallel with the tumor treatment, resulting in the eradication of her HCV infection. That same year, a recurrent tumor with a diameter of about 30 mm was found in s8, accompanied with an occlusive portal vein thrombus
Remission Characteristics
Serum AFP value had declined to 5261.8 ng/ml from 16962.3 ng/ ml in 3 months. It continued to decline to 12 ng/ml 2 months later. CT scan showed that he previously affected area of s8 enhanced in the arterial phase with an early washout pattern in the portal phase, was almost disappeared. In addition, the portal occlusion on did resolve.
Treatment & Mechanisms
Proposed Remission Mechanisms
Diminished blood supply by the thrombus in the portal vein should have caused our patient's tumor to become necrotic
Clinical Treatment
Tace, rfa, ledipasvir, sofosbuvir.