Advanced hepatocellular carcinoma treated effectively with irinotecan via hepatic arterial infusion followed by proton beam therapy

Abstract

We report a 48-year-old man with hepatocellular carcinoma (HCC) treated with hepatic arterial infusion (HAI) chemotherapy followed by proton beam therapy. The HCC lesion in this patient was 8.8 cm in diameter with portal vein tumor thrombosis in the right robe of the liver. He was first treated with 5-fluorouracil, cisplatin, and isovorin, combined with interferon-α, and subsequently with epirubicin and mitomycin-C by HAI. However, no definite efficacy was observed. After continuous administration of irinotecan by HAI, the tumor size decreased to 6.8 cm in diameter after 3 weeks. The tumor became enlarged to 10 cm in diameter after 3 months.Angiographic findings indicated that HCC was fed from not only the right hepatic artery, but also the left gastric and right and left subphrenic arteries. After rearrangement of the arteries, the tumor size decreased to 5.0 cm in diameter by continuous HAI chemotherapy with irinotecan and hyperthermia after 4 months. Since the reduction rate 4 of the main tumor was 43% in Response Evaluation Criteria in Solid Tumors, the efficacy of this case was judged partial response. Although liver tumors showed gradual enlargement during administration of docetaxel instead of irinotecan, almost of the liver tumors resulted in necroses after proton beam therapy. The patient died of hepatic failure and distant metastases 6 years after onset of HCC. As far as we know, this is the first case report of HCC treated effectively with irinotecan by HAI followed by proton beam therapy in which tumor suppression and long-term survival were observed.