A case of successfully treated advanced hepatocellular carcinoma with portal vein tumor thrombus and bile duct obstruction by multimodal therapy

A 61year-old male, consulted our hospital because of upper abdominal pain. On admission, laboratory blood examination indicated significant elevation in hepatic enzyme and bile system enzymes. By CT scan and ERCP, he was diagnosed as hepatocellular carcinoma with portal vein tumor thrombus and bile duct obstruction. Bile duct drainage was successfully performed using expandable metallic stents. Surgical resection, locoregional therapy, and TACE were contraindicated due to liver damage and portal vein tumor thrombus. Therefore, IFNα and 5-FU combined systemic chemotherapy was selected. After two courses of IFNα/5-FU therapy, the main tumor nodule became visible and the portal vein tumor thrombus decreased in size, making series of TACE and RFA possible. It has been well known that patients suffering from hepatocellular carcinoma with portal vein and bile duct tumor thrombus are poor prognosis. Long time survival may be expected by the combination of IFNα/5-FU systemic chemotherapy and multimodal therapy even in patients with advancer hepatocellular carcinoma.