title: Metastatic hepatocellular carcinoma: when surgery and successive palliative treatments lead to remission.
abstract: Hepatocellular carcinoma (HCC) is the third leading cause of death by cancer worldwide. The prognosis of patients with metastatic HCC remains limited, with an expected median survival lower than 50% at 1 year. Here, we report the case of a 63-year-old man who suffered from a small HCC in the liver and a large unique metastasis in the right adrenal gland. A surgical resection of both lesions was performed. Seven months later, HCC recurred with an isolated right renal metastatic lymphadenopathy and a high alpha-fetoprotein level. HCC was brought under control by sorafenib; the alpha-fetoprotein level was greatly reduced but remained moderately elevated and stable over 2 years after the onset of chemotherapy. Additional external radiotherapy on the metastatic lymphadenopathy led to a normalization of the alpha-fetoprotein level and discontinuation of sorafenib treatment. One year after the end of radiotherapy, a second isolated metastasis occurred in the right lung. This tumor was surgically removed. Twenty-one months after this second surgical procedure, i.e., more than 5.5 years after the initial diagnosis of metastatic HCC, the patient was asymptomatic and tumor free.
authors.affiliation: Department of Hepato-Gastroenterology, University Hospital, Angers, France.
authors.forename: Charlène
authors.initials: C
authors.lastname: Brochard
authors.affiliation: Department of Visceral Surgery, University Hospital, Angers, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Hamy
authors.affiliation: Department of Pathology, University Hospital, Angers, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Michalak
authors.affiliation: Department of Radiology, University Hospital, Angers, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Aubé
authors.affiliation: Department of Vascular and Thoracic Surgery, University Hospital, Angers, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Picquet
authors.affiliation: Department of Radiotherapy, Centre Paul-Papin, Angers, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Nebout
authors.affiliation: Department of Hepato-Gastroenterology, University Hospital, Angers, France.
authors.forename: François-Xavier
authors.initials: FX
authors.lastname: Caroli-Bosc
authors.affiliation: Department of Hepato-Gastroenterology, University Hospital, Angers, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Oberti
authors.affiliation: Department of Hepato-Gastroenterology, University Hospital, Angers, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Calès
authors.affiliation: Department of Hepato-Gastroenterology, University Hospital, Angers, France. Electronic address: JeBoursier@chu-angers.fr.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Boursier
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000556:secondary* / Q000601:surgery / Q000628:therapy*; D006528:Carcinoma, Hepatocellular / Q000556:secondary* / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D012074:Remission Induction