Regression of Tumor Thrombus in the Suprahepatic Vena Cava of Hepatocellular Carcinoma and Conversion Hepatectomy Induced by Lenvatinib

Abstract

Recent developments in systemic chemotherapy for advanced hepatocellular carcinoma have been outstanding. However, reports on conversion surgery after lenvatinib therapy are scarce. We present the first case of advanced hepatocellular carcinoma with tumor thrombus in the suprahepatic vena cava close to the right atrium, which shrank after 12 weeks’ administration of lenvatinib, thereby leading to successful conversion surgery without using total vascular exclusion or extracorporeal circulation. The treatment strategy for hepatocellular carcinoma with macroscopic hepatic vein tumor thrombus is controversial, however, from a Japanese nationwide survey, surgical resection has been accepted as one of the treatment options for advanced hepatocellular carcinoma with hepatic vein tumor thrombus in Japan. However, the survival rate after resection of hepatocellular carcinoma having inferior vena cava tumor thrombus with extracorporeal circulation was reported to be worse than without extracorporeal circulation, and some preoperative down-sizing therapy for inferior vena cava tumor thrombus was advocated. Preoperative lenvatinib therapy might be a promising option among the multidisciplinary treatments for hepatocellular carcinoma with macroscopic tumor thrombus in the hepatic veins.

Development of conversion therapy for advanced hepatocellular carcinoma

“…However, liver resection for PVTT or HVTT can be technically challenging, necessitating a major hepatectomy; recurrence-free survival is shorter than the cases without PVTT or HVTT. On the contrary, shrinking tumor thrombus with systemic or locoregional therapy makes liver resection less difficult and may improve prognosis ( 9 ).…”