Yttrium-90 radioembolization for advanced hepatocellular carcinoma with Budd-Chiari syndrome: A case report

Abstract

BACKGROUND

Hepatocellular carcinoma (HCC) with advanced features such as Budd-Chiari syndrome, chronic liver failure and multiple intrahepatic metastases poses significant therapeutic challenges. Yttrium-90 (⁹⁰Y) radioembolization is a locoregional treatment option with potential benefits in such complex cases. This case report explores the application of ⁹⁰Y radioembolization in combination with systemic therapies, highlighting its potential role in managing advanced HCC.

CASE SUMMARY

A 51-year-old male presented with HCC characterized by massive intrahepatic lesions, multiple metastases, and chronic liver failure secondary to Budd-Chiari syndrome. The patient underwent ⁹⁰Y radioembolization following hepatic arterial infusion chemotherapy and was subsequently combined with lenvatinib. Post-treatment follow-up revealed a significant reduction in tumor size, with the maximum diameter decreasing from 142.45 mm to 73.16 mm over six months. Liver function improved from Child-Pugh class B to A. However, new intrahepatic lesions emerged at ten months, and liver function deteriorated to Child-Pugh class C. The patient survived for 18 months after initial diagnosis.

CONCLUSION

Yttrium-90 radioembolization combined with systemic therapies demonstrated significant tumor regression and temporary liver function improvement in a patient with advanced HCC, suggesting its potential as a treatment option in complex cases.

Keywords: Yttrium-90; Radioembolization; Hepatocellular carcinoma; Budd-Chiari syndrome; Chronic liver failure; Case report

Core Tip: This case report highlights the successful combination of yttrium-90 radioembolization therapy and lenvatinib in treating a patient with advanced hepatocellular carcinoma characterized by large tumors, multiple intrahepatic metastases, and Budd-Chiari syndrome complicated by chronic hepatic failure. Despite the complexity of the case, this treatment approach effectively reduced tumor burden, improved liver function, and significantly prolonged the patient’s survival, offering a promising therapeutic option for similar challenging scenarios.