Successful Tace in Patient with large HCC History

Successful Tace in Patient with large HCC

History 65 y/o hispanic (Cuban) male with alcoholic + NASHrelated cirrhosis diagnosed in October 03 (since abstinent) Referred for HCC (8. 5 cm) management 10/06 PMH – – – DM Asthma Cholecystectomy Obesity Alcoholic cardiomyopathy (compensated)

Cirrhosis Hepatic encephalopathy related hospitalization H/O grade 1– 2 varices, no GI bleed No ascites/edema/jaundice Biological MELD – 12 (2006) Diagnosed with 8. 5 cm HCC in 2006 on US, CT and MRI during screening AFP in June 2006 was 12, 526

Medications Digoxin Rifaximin Fluoxetine Montelukast Bumetanide Spironolactone

TACE with ethiodol cisplatin combination and embolisation with gelfoam

Post TACE CT scan

Therapy (cont’d) Adjuvant therapy – Bevacizumab – Octreotide Tumor size 8. 5 3 cm in 4 months AFP 12, 526 3. 1(10/06)

Post TACE labs Sodium 140 Potassium 3. 6 BUN/Cr 14/0. 9 INR 1. 54 Total Bilirubin 1. 3 AST 45 ALT 50 Alk. Phosphatase 124 Albumin 2. 6 Biological MELD score 12 Hemoglobin 12. 4 HCT 37. 2 WBC 3. 3 Platelets 32 K

Liver Transplant OLT on 2/1/07 with a MELD of 17 [biological] Explant pathology – Cirrhosis with mild inflammatory activity – Area of 3 cm necrosis – No residual viable carcinoma – No vascular invasion

Post Liver Transplantation Patient doing well No complications No tumor recurrence

Follow-up triple phase CT at 2 years