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Successful Tace in Patient with large HCC

Successful Tace in Patient with large HCC

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Successful Tace in Patient with large HCC

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  1. Successful Tace in Patient with large HCC

  2. History • 65 y/o hispanic (Cuban) male with alcoholic + NASH-related cirrhosis diagnosed in October 03 (since abstinent) • Referred for HCC (8.5 cm) management 10/06 • PMH • DM • Asthma • Cholecystectomy • Obesity • Alcoholic cardiomyopathy (compensated)

  3. 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

  4. Medications Digoxin Rifaximin Fluoxetine Montelukast Bumetanide Spironolactone

  5. TACE with ethiodol cisplatin combination and embolisation with gelfoam

  6. Post TACE CT scan

  7. Therapy (cont’d) • Adjuvant therapy • Bevacizumab • Octreotide • Tumor size 8.5 3 cm in 4 months • AFP 12,526  3.1(10/06)

  8. Hemoglobin 12.4 HCT 37.2 WBC 3.3 Platelets 32K 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

  9. 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

  10. Post Liver Transplantation Patient doing well No complications No tumor recurrence

  11. Follow-up triple phase CT at 2 years