%0 Journal Article
%T Hypofractionated Stereotactic Radiotherapy after Transarterial Chemoembolisation Failure in an Unresectable Hepatocellular Carcinoma: A Case Presentation
%A Francesco Fiorica
%A Carlo Greco
%A Sergio Boccia
%A Sergio Sartori
%A Antonio Stefanelli
%A Francesco Cartei
%A Stefano Ursino
%J Case Reports in Hepatology
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/146215
%X Introduction. Transarterial chemoembolization is the first-line treatment in unresectable hepatocellular carcinoma. There is no standard treatment after transarterial chemoembolization failure. We report the case of a patient with advanced hepatocellular carcinoma who showed a complete response and a long cancer control with hypofractionated stereotactic radiotherapy after transarterial chemoembolization failure. Case Presentation. A 70-year-old Caucasian woman was treated with transarterial chemoembolization for advanced hepatocellular, but no cancer control was obtained. A hypofractionated stereotactic radiotherapy was planned delivering 40£¿Gy in 5 fractions. A dramatic reduction in alpha-fetoprotein was observed. Contrast-enhanced ultrasonography at 1 and 2 months showed large necrotic areas. Computerised tomography scan showed a 90% objective tumour response, then a complete remission at 3 and 6 months after treatment, respectively. Status of patient remained unchanged for 2 years. Conclusions. Hypofractionated stereotactic radiotherapy can improve survival and prognosis of unresectable hepatocellular carcinoma patient. 1. Introduction Hepatocellular carcinoma (HCC) is a very heterogeneous disease, and the management of therapeutic approach may be variable and strongly related to patient¡¯s liver dysfunction as well as tumour stage [1]. A patient affected by intermediate or advanced stage HCC is only candidate for a palliative treatment. Transarterial chemoembolization (TACE) is standard treatment of unresectable HCC [2]; however, prognosis of these patients remains dismal, especially when TACE fails. Hypofractionated stereotactic radiotherapy (HSRT) can lead to a significant benefit for patients affected by intermediate or advanced HCC, alone or combined with TACE [3]. We report the case of a patient with advanced HCC who showed a complete response and a long cancer control with HSRT after TACE failure. 2. Case Presentation A 70-year-old woman, with a history of alcoholic cirrhosis was admitted to our hospital because a liver mass had been discovered by ultrasonography scan. Her Eastern Cooperative Oncology Group (ECOG) performance score was 1. Physical examination showed no palpable mass, abdominal distension, or weight loss. Laboratory details showed white blood cell 5,980/¦ÌL; red blood cell 4,24 ¡Á 106/¦ÌL; haemoglobin 10,8£¿g/dL; hematocrit 35%; platelet 137,000/¦ÌL; INR 1,11; urea nitrogen 26£¿mg/dL; creatinine 0,73£¿mg/dL; total protein 7,8£¿g/dL; albumin 3,5£¿g/dL; aspartate aminotransferase (AST) 55£¿U/L; alanine aminotransferase (ALT) 42£¿U/L;
%U http://www.hindawi.com/journals/crihep/2013/146215/