Successful resection of huge hepatocellular carcinoma with inferior vena cava thrombus after downsizing by three-dimensional conformal radiation therapy and transarterial chemoembolization

We report a successfully managed case of locally far-advanced hepatocellular carcinoma (HCC) by preoperative downsizing by transarterial chemoembolization (TACE) and three-dimensional conformal radiation therapy (3D-CRT), with subsequent surgical resection. A 35-year-old man was referred to our hospital with right huge HCC in May, 2006. The laboratory data were normal except for elevated aspartate transaminase 100 U/L (0-38), alanine transaminase 54 U/L(0-44), and α-fetoprotein 32 ng/mL(1-8). A computed tomography scan of the liver revealed a 20-cm right side huge HCC with inferior vena cava tumor thrombus (IVC-TT) and a second 2-cm HCC in segment III. TACE was performed on the right HCC with 20 mg of doxorubicin (Adriamycin), mixed with 10 mL of lipiodol and gelfoam. 3D-CRT was followed by 60 Gy (3 Gy/fraction) over 4 weeks. The posttreatment computed tomography scan showed significant shrinkage of the right tumor and IVC-TT. The tumors with the concomitant IVC-TT were surgically removed 6 weeks later.