title: [Successful Multimodal Treatment for Aggressive Extrahepatic Metastatic Hepatocellular Carcinoma - A Case Report].
abstract: A 38-year-old man underwent right hepatectomy for a huge hepatocellular carcinoma(HCC)in the right hepatic lobe. Four months later, recurrent and metastatic disease were observed in the remnant liver and right lung, respectively. We performed a hepatectomy for the recurrent lesion because transcatheter arterial chemoembolization (TACE) was not effective. After surgery, we initiated sorafenib treatment for the lung metastases. One year later, the lung metastases worsened and metastases were observed in the mediastinal lymph nodes, and both metastatic lesions were resected. Seven months later, para-aortic lymph nodal metastasis was observed and dissected. Three months later, metastasis to the supraclavicular lymph node was observed. We performed particle radiation therapy and a complete response was achieved. One year later, metastases in both lungs were observed and resected. Despite continued sorafenib administration throughout the clinical course, a metastasis to the left adrenal gland was observed. This lesion was extirpated because no other recurrent lesions were detected. At 4 years and 6 months after the first operation, no other recurrences have occurred. Currently, sorafenib is the initial drug of choice for HCC with extrahepatic metastases. It is possible to improve the prognosis of patients with HCC and extrahepatic metastases by applying surgical treatment during the course of sorafenib administration.
authors.affiliation: Dept. of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University, Graduate School of Medicine.
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Gon
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kido
authors.forename: Takumi
authors.initials: T
authors.lastname: Fukumoto
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takebe
authors.forename: Motofumi
authors.initials: M
authors.lastname: Tanaka
authors.forename: Kaori
authors.initials: K
authors.lastname: Kuramitsu
authors.forename: Hisoka
authors.initials: H
authors.lastname: Kinoshita
authors.forename: Kenji
authors.initials: K
authors.lastname: Fukushima
authors.forename: Takeshi
authors.initials: T
authors.lastname: Urade
authors.forename: Shinichi
authors.initials: S
authors.lastname: So
authors.forename: Makoto
authors.initials: M
authors.lastname: Shinzeki
authors.forename: Ippei
authors.initials: I
authors.lastname: Matsumoto
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Ajiki
authors.forename: Yonson
authors.initials: Y
authors.lastname: Ku
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D003131:Combined Modality Therapy; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000628:therapy*; D008175:Lung Neoplasms / Q000556:secondary / Q000628:therapy; D008297:Male; D009536:Niacinamide / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000627:therapeutic use*; D012008:Recurrence; D012074:Remission Induction; D000077157:Sorafenib
chemical_list: D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D009536:Niacinamide; D000077157:Sorafenib