A case of hepatocellular carcinoma with right atrium tumor thrombus and multiple intrahepatic metastases that remarkably responded to combination therapy including surgery

The prognosis for hepatocellular carcinoma (HCC) with right atrium tumor thrombus (RATT) is dismal and necessary to be treated on as oncologic emergency. We report a case of HCC with RATT which was treated with multidisciplinary therapy including surgery. After repeated transarterial chemoembolization (TACE) and radiofrequency ablation (RFA),a 71-year-old man consulted to our hospital with multiple HCC, lung metastasis, and RATT. Left hemihepatectomy, thrombectomy of RATT, and 3 months of hepatic arterial infusion chemotherapy (HAIC) was performed, and intrahepatic HCCs were controlled. However, during treatment of lung metastasis by sorafenib, the patient died of brain metastasis, 3 years after the first treatment. Although surgery and HAIC may give a chance of further treatment by control of intrahepatic HCCs, stronger regimen for systemic HCC would be necessary.