Long-Term Survival under Arterial Chemoembolization and Sorafenib of a Patient with Hepatocellular Carcinoma and Tumor Atrial Thrombus: A Case Report and Literature Review

Abstract

Hepatocellular carcinoma (HCC) is considered to be the fourth most frequent cause of cancerassociated death globally. HCC might be associated, especially in advanced stages, with the formation of tumor thrombus (TT), which can be located in the portal vein, as well as in hepatic and/or inferior vena cava (IVC) veins. Nevertheless, the extension of TT to the right atrium (RA) is infrequent with an unfavorable prognosis. We present a rare case of a male patient with HCC and IVC TT extending to the RA. The atrial thrombus was the first manifestation of HCC diagnosed by cardiac ultrasound. So far, the patient has undergone 4 courses of transarterial chemoembolization in combination with systemic therapy with sorafenib, and under this therapeutic approach long-term survival has been achieved.

Transarterial Radioembolization Treatment of Advanced Hepatocellular Carcinoma Invading the Right Atrium

“…However, many other treatment strategies have been attempted with varying response efficiencies. These therapies include surgical treatments such as TT resection and non-surgical options such as external beam therapy, Transarterial Chemoembolization (TACE), and TARE [3].…”

“…However, due to the risk of circulatory failure and the poor general status of patients with HCC RA TT, this approach is not compatible with all patients. Likewise, External beam radiation therapy is also not suitable for all patients due to the associated severe adverse effects and liver toxicity that may result from radiation doses exceeding 35 Gy [3,4,12].…”

“…Intravascular TT can further progress and extend into the inferior vena cava (IVC) and the right atrium (RA). Prognosis in such cases is extremely poor, with a median survival of about 2-5 months without treatment [3]. Although there are various possible treatments proposed (surgery, radio ablation, trans-arterial radioembolization (TARE), and combination treatments), there is still no optimal one established for TT infiltration of the RA [4].…”