Posttransplant sequential adrenal and spine metastasis of hepatocellular carcinoma responsive to combined regorafenib and radiotherapy: a case report

Abstract

Adrenal and spinal metastases of hepatocellular carcinoma (HCC) are rare entities with significant morbidity and mortality, particularly after liver transplantation (LT). We report a case of a 49-year-old man who underwent LT for hepatitis B-related end-stage liver disease and HCC (single 4.5 cm lesion [T1N0], without vascular invasion) in 2016. Eighteen months later, adrenal metastasis and hepatitis B seropositive conversion were developed with normal serum tumor. Adrenal metastasis was treated with radiation therapy (RT) and hepatitis B showed spontaneous seronegative conversion. However, 35 months later, spinal metastasis occurred with elevation of the protein induced by vitamin K absence or antagonist-II (PIVKA-II) level (197 mAU/mL), along with hepatitis B seropositive conversion. After sorafenib, sequential regorafenib with RT led to partial response of the spinal lesions, along with hepatitis B seronegative conversion and normal PIVKA-II levels. After 9 months of regorafenib combined with RT, two recurrent lesions were found, as well as hepatitis B seropositive conversion and lesions were treated with transarterial chemoembolization. The patient survived for more than 71 months after LT and 53 months after recurrence under various combinations of therapy. Combined systemic and locoregional therapies can be a treatment option for HCC recurrence, even in LT patients.

Case report: long-term sustained remission in a case of metastatic colon cancer with high microsatellite instability and KRAS exon 2 p.G12D mutation treated with fruquintinib after local radiotherapy: a case report and literature review

“…A clinical trial named REGINA aims to evaluate the survival benefits of neoadjuvant regorafenib in combination with nivolumab and short-course RT for stage II and III rectal cancer, the results of which are highly anticipated ( Bregni et al, 2021 ). A previous case showed that a patient with metastatic hepatocellular carcinoma achieved long-term survival of over 71 months after receiving a combination of regorafenib and RT ( Kim et al, 2023 ). RT may improve the tumor microenvironment, promote the release of tumor antigen, and synergistically increase the effects of TKIs and ICIs.…”

Manufacturing of spherical activated carbons using anion exchange resins and analysis of the properties

“…Among them, activated carbons are one of the most representative adsorbents with low production costs and properties such as abundant micropores, large surface areas, high adsorption performance, acid/base, and thermal stability [1]. Due to such properties, activated carbons are widely used in diverse liquid-phase and gas-phase processes such as the treatment of heavy metals in wastewater and landfill leachate, CO 2 capture, hydrogen storage, super capacitor and VOCs adsorption [2][3][4]. Since activated carbons are usually made from natural materials such as coconut shells, coal, wood, and petroleum pitch, they are in the form of fine powder or low-stability granules.…”