The Korean Journal of Hepatology 2010;16:405-409 DOI: 10.3350/kjhep.2010.16.4.405 Case Report A case of hepatocellular carcinoma in the caudate lobe successfully treated by transcatheter arterial chemoembolization using drug-eluting beads Dong Hoo Joh3, Jin Dong Kim 1 , Young Nam Kim 1 , Ha Hun Song2, Hyun Kim 2 , Kyung Ho Song1, Sang Jin Lee1, Jeong Rok Lee1, Won Joong Jeon1, Byung Hyo Cha1 1Department of Internal Medicine and 2Department of Radiology, Cheju Halla General Hospital, Jeju, Korea, 3Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea Hepatocellular carcinoma (HCC) in the caudate lobe remains one of the most intricate locations where various treatments tend to pose problems with regard to the optimal approach. Surgical resection has been regarded as the most effective treatment; however, isolated resection of the caudate lobe is strenuous and associated with a high rate of early recurrence. Percutaneous ablation might be technically difficult or impossible to perform due to the deep location of tumors and adjacent large vessels. Treatment with drug-eluting beads (DEB) can potentially enhance the therapeutic efficacy for patients with unresectable HCC by drawing on the slower, more consistent drug delivery process. We described a case of a 62-year-old man with HCC in the caudate lobe who was successfully treated by DEB. (Korean J Hepatol 2010;16:405-409) Keywords: Carcinoma, Hepatocellular; Chemoembolization; Drug-eluting beads; Caudate lobe INTRODUCTION Hepatocellular carcinoma (HCC) is a common tumor with a poor prognosis especially in the hepatitis B endemic country such as Korea. Surgical resection, liver transplantation, and percutaneous ablation are generally accepted as the only curative treatments for HCC.1 Transcatheter arterial chemoembolization early-staged caudate HCC which was treated completely by TACE using DEB. CASE REPORT A 62-year-old man with alcoholic cirrhosis visited outpatient clinic for unexplained weight loss. He had a good performance (TACE) is the standard first-line treatment for patients with status (grade 0). Laboratory tests showed serum albumin level of inoperable and intermediate HCC, but response rates and 5.3 g/dL, bilirubin level of 1.3 mg/dL, and prothrombin time evidence of a survival benefit is relatively low.2 Although there international normalized ratio of 1.1. Neither ascites nor hepatic are several therapeutic options for the treatment of HCC, HCC in encephalopathy was found, which corresponded with Child-Pugh the caudate lobe is regarded as a clinical hot potato owing to class A. Serologic markers for hepatitis B and C were negative. limitation of applicable therapeutic method pertinent to the Serum α-fetoprotein level was 311.7 ng/mL, and PIVKA-II level lesion. was over 2,000 mAU/mL. Other laboratory findings including Recently, drug delivery embolization system, that is drug- tumor markers and thyroid function tests were within normal eluting beads (DEB), with the ability to sequester chemotherapeutic limits. About a 5 cm sized ovoid enhancing mass in arterial phase agent from solution and release it in a sustained and controlled involving the caudate lobe with underlying cirrhotic configuration 3 mode were introduced for TACE. We described a case of of the liver was shown on the dynamic computed tomography Received June 26, 2010; Revised September 15, 2010; Accepted October 7, 2010 Abbreviations: BCLC, Barcelona-Clinic-Liver-Cancer; CT, computed tomography; DEB, drug-eluting beads; HCC, hepatocellular carcinoma; MRI, magnetic resonance imaging; TACE, transcatheter arterial chemoembolization Corresponding author: Jin Dong Kim Department of Internal Medicine, Digestive Disease Center, Cheju Halla General Hospital, #1963-2 Yeon-dong, Jeju 690-766, Korea. Tel. +82-64-740-5082, Fax. +82-64-740-5652, E-mail; motet76@gmail.com Copyrights Ⓒ 2010 by The Korean Association for the Study of the Liver The Korean Journal of Hepatology∙pISSN: 1738-222X eISSN: 2093-8047