Identification of extrahepatic metastases(EHM) of hepatocellular carcinoma(HCC) has been paradoxically increasing due to an increase in the survival of HCC patients. However, metastasis of HCC to the skeletal muscle t...Identification of extrahepatic metastases(EHM) of hepatocellular carcinoma(HCC) has been paradoxically increasing due to an increase in the survival of HCC patients. However, metastasis of HCC to the skeletal muscle tissue is extremely rare. We describe a unique case of HCC metastasizing to the paravertebral muscle. A 55-year-old man with a history of hepatitis B cirrhosis underwent partial liver resection with complete removal of HCC. Three months later, a computed tomography(CT) scan showed intrahepatic recurrence. The tumors were treated with yttrium-90 microspheres, transcatheter arterial chemoembolization, and sorafenib. Six months later, a CT scan showed an enhancing lesion of the left paravertebral muscle that on biopsy were consistent with metastatic HCC. The tumor was treated with stereotactic hypo-fractionated imageguided radiation therapy(SHFRT). A follow-up scan 3 mo post-radiotherapy revealed a stable appearance of the paravertebral muscle metastasis. Because of the progression in the intrahepatic tumors, the patient was treated with capecitabine, which was changed to dasatinib 6 mo later. The patient passed away three years after the primary surgical resection. Management of EHM poses an extreme challenge. This is the first case of HCC with EHM to the paravertebral muscle in which stability of disease was achieved using SHFRT. This case highlights the importance of early detection of hepatitis B viral infection and initiation of anti-viral therapy to decrease recurrence of HCC and prevent EHM.展开更多
Patients with hepatocellular carcinoma(HCC)often present with underlying liver disease and significant comorbidities,limiting treatment tolerance.With the development of improved toxicity models and highly conformal r...Patients with hepatocellular carcinoma(HCC)often present with underlying liver disease and significant comorbidities,limiting treatment tolerance.With the development of improved toxicity models and highly conformal radiation delivery systems,external beam radiotherapy has become a valuable treatment option for liver cancer.Using cutting edge technology,stereotactic ablative radiotherapy(SABR)allows for the delivery of ablative doses in few fractions while sparing uninvolved liver tissue.This approach permits dose escalation and precise tumor targeting with minimal risk of radiation induced liver disease.This review clarifies SABR's role alongside liver-directed treatments such as radiofrequency ablation,transarterial radioembolization,and transarterial chemoembolization in the management of HCC.It also examines the promising potential of SABR combined with immunotherapy to treat advanced HCC.展开更多
文摘Identification of extrahepatic metastases(EHM) of hepatocellular carcinoma(HCC) has been paradoxically increasing due to an increase in the survival of HCC patients. However, metastasis of HCC to the skeletal muscle tissue is extremely rare. We describe a unique case of HCC metastasizing to the paravertebral muscle. A 55-year-old man with a history of hepatitis B cirrhosis underwent partial liver resection with complete removal of HCC. Three months later, a computed tomography(CT) scan showed intrahepatic recurrence. The tumors were treated with yttrium-90 microspheres, transcatheter arterial chemoembolization, and sorafenib. Six months later, a CT scan showed an enhancing lesion of the left paravertebral muscle that on biopsy were consistent with metastatic HCC. The tumor was treated with stereotactic hypo-fractionated imageguided radiation therapy(SHFRT). A follow-up scan 3 mo post-radiotherapy revealed a stable appearance of the paravertebral muscle metastasis. Because of the progression in the intrahepatic tumors, the patient was treated with capecitabine, which was changed to dasatinib 6 mo later. The patient passed away three years after the primary surgical resection. Management of EHM poses an extreme challenge. This is the first case of HCC with EHM to the paravertebral muscle in which stability of disease was achieved using SHFRT. This case highlights the importance of early detection of hepatitis B viral infection and initiation of anti-viral therapy to decrease recurrence of HCC and prevent EHM.
文摘Patients with hepatocellular carcinoma(HCC)often present with underlying liver disease and significant comorbidities,limiting treatment tolerance.With the development of improved toxicity models and highly conformal radiation delivery systems,external beam radiotherapy has become a valuable treatment option for liver cancer.Using cutting edge technology,stereotactic ablative radiotherapy(SABR)allows for the delivery of ablative doses in few fractions while sparing uninvolved liver tissue.This approach permits dose escalation and precise tumor targeting with minimal risk of radiation induced liver disease.This review clarifies SABR's role alongside liver-directed treatments such as radiofrequency ablation,transarterial radioembolization,and transarterial chemoembolization in the management of HCC.It also examines the promising potential of SABR combined with immunotherapy to treat advanced HCC.
