A case of multiple hepatocellular carcinoma with tumor thrombus of portal vein, successfully treated by multimodal therapy including proton irradiation

An HBsAg-positive 43 years old man received proton radiotherapy (fraction size 2Gy, total dose 70Gy) for a large hepatocellular carcinoma (HCC) complicated with tumor thrombus of the main trunk of portal vein in March 2004. Four months later, however, he was admitted to our hospital because multiple new lesions of HCC developed. Angiography on admission indicated multiple nodular staining in left lobe of the liver but no signs for tumor thrombus in the portal vein. He was then treated with transcatheter arterial chemoembolization (TACE) with epirubicin hydrochloride (EPI), followed by a continuous arterial infusion therapy using low doses of cisplatin hydrochloride (CDDP) and 5-fluorouracil (5-FU). After the first course of the chemotherapy, all the tumor stains had disappeared on angiography, and the serum levels of tumor markers had decreased significantly as well. With additional courses of chemotherapy thereafter, the patient remains free from relapses of HCC for more than 2 years until now.