Unresectable Hepatocellular Carcinoma: case 2 - Episode 4
potential for systemic therapy is good. Systemic therapy should be considered after second TACE if there is residual disease.
Dr. Nissen believes the
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 patientâ€™s ongoing alcohol use, and patient achieved a partial response (>30% decrease by RECIST criteria)
In April 2014, the patient returns for follow up
Patientâ€™s lab values include:
AFP: 1100 ng/mL; AST 322 IU/L
ALT: 195 IU/L
Total bilirubin: 1.8 mg/dL
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