A case of esophageal variceal bleeding induced by portal vein tumor thrombus of hepatocellular carcinoma, effectively treated with combined intra-arterial 5-fluorouracil and pegylated interferon-α therapy

Abstract

A 66-year-old Japanese man was admitted to our hospital because of hematemesis with esophageal variceal hemorrhage induced by portal vein tumor thrombus (PVTT) with advanced hepatocellular carcinoma (HCC). He had been treated with RFA to HCC in hepatic S6 that related HCV liver cirrhosis before this admission. He also had been treated with hepatic arterial infusion chemotherapy (3days FPL therapy) prior to this admission. Despite of these treatments, his HCC had progressed and abdominal CT revealed the advanced diffused type HCCs located in hepatic S6, 7 and the obstruction of right portal vein branch due to tumor invasion. Since the ascites and frequent hemorrhage from esophageal varices were observed, we had treated this patient with pegylated interferon-α (PEG-IFN) with 5FU (Peg-IFN/5FU). After 1 course administration, esophageal varices disappeared and the obstructed right portal vein branch have recanalized. Although the advanced HCC with PVTT and esophageal varices were potentially fatal, Peg-IFN/5FU was effective and contributed to improve the prognosis of HCC patient. This case suggests that Peg-IFN/5FU was useful and should be considered to the other chemotherapeutic-agents resistant HCC.