A case of successful surgical treatment for peritoneal seeding of hepatocellular carcinoma after radiotherapy and atezolizumab plus bevacizumab combination treatment

Abstract

Peritoneal seeding of hepatocellular carcinoma (HCC) is incurable and has poor prognosis. A 68-year-old man underwent surgical resection for a 3.5 cm single nodular HCC at the tip of segment 3 and transarterial chemoembolization for a 1.5 cm-sized recurrent HCC at the tip of segment 6. 3 months later, an increasing 1 cm pelvic nodule on the rectovesical pouch warranted radiotherapy. Although it stabilized, a new 2.7 cm-sized peritoneal nodule in the right upper quadrant (RUQ) omentum appeared 3.5 years after radiotherapy. Hence, omental mass and small bowel mesentery mass excision were performed. 3 years later, recurrent peritoneal metastases in the RUQ omentum and rectovesical pouch progressed. 33 cycles of atezolizumab and bevacizumab treatment elicited stable disease response. Finally, laparoscopic left pelvic peritonectomy was performed without tumor recurrence. Herein, we present a case of HCC with peritoneal seeding that was successfully treated with surgery after radiotherapy and systemic therapy, leading to complete remission.

Analysis of Factors Predicting the Real-World Efficacy of Atezolizumab and Bevacizumab in Patients with Advanced Hepatocellular Carcinoma

“…Several case reports have indicated the successful treatment of HCC with peritoneal seeding using atezolizumab and bevacizumab. 13 , 14 Although the mechanism is not fully understood, the observed responsiveness of peritoneal seeding in HCC to atezolizumab and bevacizumab may be related to specific aspects of tumor biology or the immune environment and response. Thus, further research is needed to explore these factors.…”

Feasibility of additional radiotherapy in patients with advanced hepatocellular carcinoma treated with atezolizumab plus bevacizumab

“…Thus, the addition of RT to combined treatment with immunotherapeutic and anti-angiogenic agents (i.e., atezolizumab and bevacizumab) could enhance treatment outcomes by creating a synergistic effect. 12 - 16 , 32 - 34 However, the safety and efficacy of additional RT in patients with advanced HCC undergoing treatment with atezolizumab plus bevacizumab remain unclear. Thus, we retrospectively evaluated patients with advanced HCC who received additional RT during treatment with atezolizumab plus bevacizumab and assessed the feasibility of additional RT in these patients.…”