Unresectable Hepatocellular Carcinoma: case 2 - Episode 3

Nicholas Nissen, MD: Estimate of TACE Procedures

CASE 2: Unresectable Hepatocellular Carcinoma

Steve C is a 56-year-old Caucasian construction worker from Miami, Florida with a history of chronic hepatitis C virus (HCV) infection and alcohol abuse.

In January of 2013 the patient was diagnosed with unresectable hepatocellular carcinoma, with an encapsulated, 7-cm tumor identified in the right lobe on Gadolinium-enhanced MRI

Multidisciplinary team recommended TACE because of patient’s ongoing alcohol use, and patient achieved a partial response (>30% decrease by RECIST criteria)

In April 2014, the patient returns for follow up

Patient’s lab values include:

AFP: 1100 ng/mL; AST 322 IU/L

ALT: 195 IU/L

Total bilirubin: 1.8 mg/dL

Platelets: 85,000

At his current workup, the patient is classified as Child Pugh Class A, with a MELD score of 13; ECOG PS is 1

MRI with gadolinium is consistent with disease progression, with encapsulated lesion in the right lobe measuring 9 cm, consistent with HCC

A third TACE procedure is recommended by the MDT

Following the TACE procedure, imaging results show 65% necrosis in the treated area with residual 1.5-cm nodules