title: Combination of sorafenib and intensity modulated radiotherapy for unresectable hepatocellular carcinoma.
abstract: Unresectable hepatocellular carcinoma (HCC) has a poor therapeutic outcome. We report here on a 40-year-old male HCC patient who had undergone partial hepatectomy and was refractory to therapeutic embolization. In addition, the tumour expressed phosphorylated extracellular signal-regulated kinase and CD34. Sorafenib was administered as salvage treatment and resulted in a rapid decline in alpha-fetoprotein (AFP) levels. However, this was accompanied by a grade 3 skin reaction, which improved as sorafenib dosage was gradually reduced. Unfortunately, reducing the dose of sorafenib also resulted in a rebound in AFP levels and portal vein thrombosis was noted thereafter. Sorafenib 800 mg/day was resumed, but the tumour failed to respond. Intensity-modulated radiation therapy (IMRT) combined with sorafenib was administered, resulting in marked tumour shrinkage and causing recurrence of the systemic skin reaction and development of photosensitivity. The patient survived for 20 months after the start of sorafenib treatment. This case suggests that the combination of sorafenib and IMRT might provide clinical benefits in patients with HCC who express potential targets but fail to respond to sorafenib; however, skin reactions should be monitored.
authors.affiliation: Department of Radiation Oncology, Far Eastern Memorial Hospital, Taipei, Taiwan.
authors.forename: Chen-Hsi
authors.initials: CH
authors.lastname: Hsieh
authors.forename: Kuo-Shyang
authors.initials: KS
authors.lastname: Jeng
authors.forename: Ching-Chung
authors.initials: CC
authors.lastname: Lin
authors.forename: Chi-Kuan
authors.initials: CK
authors.lastname: Chen
authors.forename: Chia-Yuan
authors.initials: CY
authors.lastname: Liu
authors.forename: Chin-Ping
authors.initials: CP
authors.lastname: Lin
authors.forename: Hung-Chi
authors.initials: HC
authors.lastname: Tai
authors.forename: Chao-Hsing
authors.initials: CH
authors.lastname: Wang
authors.forename: Pei-Wei
authors.initials: PW
authors.lastname: Shueng
authors.forename: Yu-Jen
authors.initials: YJ
authors.lastname: Chen
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001557:Benzenesulfonates / Q000009:adverse effects / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy* / Q000532:radiotherapy*; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D008297:Male; D009536:Niacinamide / Q000031:analogs & derivatives; D010671:Phenylurea Compounds; D011725:Pyridines / Q000009:adverse effects / Q000627:therapeutic use*; D050397:Radiotherapy, Intensity-Modulated / Q000295:instrumentation / Q000379:methods; D016879:Salvage Therapy; D000077157:Sorafenib; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D001557:Benzenesulfonates; D010671:Phenylurea Compounds; D011725:Pyridines; D009536:Niacinamide; D000077157:Sorafenib