Case Report
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Mar 15, 2025; 17(3): 100861
Published online Mar 15, 2025. doi: 10.4251/wjgo.v17.i3.100861
Combination therapy strategy based on selective internal radiation therapy as conversion therapy for inoperable giant hepatocellular carcinoma: A case report
Ming-Zhi Hao, Hai-Lan Lin, Yu-Bin Hu, Qi-Zhong Chen, Zhang-Xian Chen, Lin-Bin Qiu, Duan-Yu Lin, Hui Zhang, De-Chun Zheng, Zhu-Ting Fang, Jing-Feng Liu
Ming-Zhi Hao, Hai-Lan Lin, Yu-Bin Hu, Qi-Zhong Chen, Zhang-Xian Chen, Department of Tumor Interventional Radiology, Clinical Ocology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou 350014, Fujian Province, China
Lin-Bin Qiu, Department of Oncology and Vascular Interventional Radiology, Clinical Oncology School of Fujian Medical University, Fuzhou 350014, Fujian Province, China
Duan-Yu Lin, Department of Nuclear Medicine, Clinical Oncology School of Fujian Medical University, Fuzhou 350014, Fujian Province, China
Hui Zhang, Department of Hepatopancreatobiliary Surgical Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou 350014, Fujian Province, China
De-Chun Zheng, Department of Radiology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou 350014, Fujian Province, China
Zhu-Ting Fang, Department of Oncology and Vascular Interventional Radiology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou 350014, Fujian Province, China
Jing-Feng Liu, Department of Hepatobiliary Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou 350014, Fujian Province, China
Co-corresponding authors: Zhu-Ting Fang and Jing-Feng Liu.
Author contributions: Hao MZ was responsible for analysis and interpretation of data, and drafting of the manuscript; Hao MZ, Lin HL, Fang ZT, and Liu JF were responsible for study concept and design; Chen ZX and Qiu LB were responsible for acquisition of data; Lin DY and Zheng DC were responsible for critical revision of the manuscript for important intellectual content; all of the authors read and approved the final version of the manuscript to be published.
Supported by The Fujian Key Laboratory of Translational Cancer Medicine and The Yttrium Little Red Flower Health Fund Project of Henan Sunshine Medical and Health Development Foundation, No. HKP2024001.
Informed consent statement: Written informed consent was obtained from patient.
Conflict-of-interest statement: The authors has not received any specific funding or research support related to the work submitted in this manuscript within the last five years.
CARE Checklist (2016) statement: The authors have read the CARE Checklist statement, and the manuscript was prepared and revised according to the CARE Checklist statement.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jing-Feng Liu, PhD, Department of Hepatobiliary Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, No. 420 Fuma Road, Fuzhou 350014, Fujian Province, China. drjingfeng@126.com
Received: August 28, 2024
Revised: December 29, 2024
Accepted: January 13, 2025
Published online: March 15, 2025
Processing time: 169 Days and 22.4 Hours
Abstract
BACKGROUND

Hepatocellular carcinoma (HCC) has become a growing health concern globally. Microvascular invasion and high tumor burden are key factors limiting the curative effect of selective internal radiation therapy (SIRT).

CASE SUMMARY

This case study reports a 49-year-old woman who was diagnosed with China Liver Cancer Staging (CNLC) IIIa HCC and > 15 cm tumor diameter. Initially, due to insufficient future liver remnant and vascular invasion, the tumor was unresectable; however, radical hepatectomy was performed after successful conversion therapy with SIRT using yttrium-90 (90Y) resin microspheres followed by hepatic arterial infusion chemotherapy (HAIC) with tyrosine kinase inhibitor (TKI) and anti-programmed death-1 (PD-1) antibody. SIRT using 90Y resin microspheres was given by the right hepatic artery and chemoembolization was simultaneously performed in the tumor’s feeding vessels from the right diaphragmatic artery. HAIC was followed every three weeks with lenvatinib and tislelizumab. At 4 months post-SIRT, the tumor was downstaged to CNLC Ib and the patient successfully underwent hepatectomy. The histopathological examination of the resected specimen showed extensive necrosis.

CONCLUSION

This case study provides evidence for an integrated treatment strategy combining SIRT and HAIC with TKI and anti-PD-1 antibodies for patients with large HCC and microvascular invasion. Further confirmatory trials are required in the future.

Keywords: Selective internal radiation therapy; Hepatic arterial infusion chemotherapy; Yttrium-90 resin microspheres; Hepatocellular carcinoma; Conversion therapy; Case report

Core Tip: Although selective internal radiation therapy (SIRT) has been used to treat unresectable hepatic cancers for more than 20 years, it is mainly employed to treat patients with ≤ 8 cm tumor size. This research reports a hepatocellular carcinoma patient with > 15 cm hepatic mass, microvascular invasion, and China Liver Cancer Staging (CNLC) IIIa who received radical hepatectomy after successful conversion therapy with SIRT using yttrium-90 resin microspheres followed by hepatic arterial infusion chemotherapy using anti-programmed death-1 antibody and tyrosine kinase inhibitor. After 4 months of SIRT, the tumor was downstaged to CNLC Ib and the future liver remnant increased from 434 mL to 802 mL.