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Conversion surgery after lenvatinib treatment for multiple lung metastases from hepatocellular carcinoma

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Abstract

Although systemic treatment for hepatocellular carcinoma has advanced after the development of tyrosine kinase inhibitors such as sorafenib and lenvatinib, the effectiveness of a single tyrosine kinase inhibitor in survival extension of unresectable hepatocellular carcinoma is limited to a few months. Therefore, novel treatment options are required for unresectable hepatocellular carcinomas, including those with multiple lung metastases. This case report describes a hepatocellular carcinoma patient with a recurrence of multiple lung metastases, which was successfully treated with conversion pneumonectomy after treatment with tyrosine kinase inhibitors. A 79-year-old man underwent right hepatectomy for hepatocellular carcinoma, along with removal of the tumor thrombus in the inferior vena cava. Multiple lung metastases were detected 4 months after hepatectomy. Treatment with tyrosine kinase inhibitors, mainly lenvatinib, resulted in complete remission of the lung metastases, except for one lesion in segment 3 of the right lung which gradually enlarged. Twenty-three months after hepatectomy, partial resection of the right lung was performed using video-assisted thoracic surgery for this residual lesion in the right lung. The patient remained disease-free for 11 months after conversion pneumonectomy, without any adjuvant therapies. This is the first case report of multiple lung metastases originating from hepatocellular carcinoma which were successfully treated with conversion pneumonectomy after treatment with tyrosine kinase inhibitors. Conversion pneumonectomy after systemic therapy with tyrosine kinase inhibitors should be considered as a treatment strategy for patients with unresectable multiple lung metastases from hepatocellular carcinomas.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita 15, Nishi 7, Kita-ku , Sapporo, Hokkaido, 060-8638, Japan

    Shunji Sano, Yoh Asahi, Toshiya Kamiyama, Tatsuhiko Kakisaka, Tatsuya Orimo, Akihisa Nagatsu, Takeshi Aiyama, Hirofumi Kamachi & Akinobu Taketomi

  2. Department of Surgery, JCHO Hokkaido Hospital, 8-3-18, Nakanoshima, Toyohiraku, Sapporo, Hokkaido, 062-8618, Japan

    Keizo Kazui, Hiroki Shomura, Shinya Ueki, Yuzuru Sakamoto & Chisato Shirakawa

  3. Department of Surgical Pathology, Hokkaido University Hospital, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan

    Hirokazu Sugino & Tomoko Mitsuhashi

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  1. Shunji Sano
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Correspondence to Yoh Asahi.

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Sano, S., Asahi, Y., Kamiyama, T. et al. Conversion surgery after lenvatinib treatment for multiple lung metastases from hepatocellular carcinoma. Int Canc Conf J 12, 7–13 (2023). https://doi.org/10.1007/s13691-022-00567-6

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