Stereotactic Body Radiotherapy Treatment of Child-Pugh C Hepatocellular Carcinoma with Inferior Vena Cava Tumor Thrombus

Abstract

The presence of tumor thrombus extending into the inferior vena cava (IVC) is a rare complication of hepatocellular carcinoma (HCC), presenting in only 3.8% of patients, resulting in a median survival of 1.9 months. Even rarer and likely with worse outcomes is a tumor extending from the IVC into the right atrium and ventricle. Here we present the case of a 55-year-old male with advanced liver cirrhosis from nonalcoholic steatohepatitis (NASH) with a diagnosis of HCC and IVC tumor thrombus invading into the right atrium and ventricle. The patient was treated with stereotactic body radiotherapy (SBRT) to 30Gy in 5 fractions delivered over 5 days targeting the right atrium, right ventricle and the outflow tract. Initially, the patient had a radiographic and clinical response to treatment, with minimal acute toxicities. Unfortunately, due to declining liver function, the patient subsequently entered hospice care and died 4 months posttreatment. This case demonstrates the poor prognosis of this advanced presentation of disease but suggests that SBRT is a safe and reasonable treatment approach for the reduction of IVC and cardiac tumor thrombus in HCC.