Điều trị đa mô thức nhằm đạt mục tiêu điều trị triệt căn ở bệnh nhân ung thư biểu mô tế bào gan kích thước lớn quá chỉ định phẫu thuật: Báo cáo một trường hợp

Abstract

A 29-year-old female patient with a history of chronic hepatitis B was found to have a large hepatic mass in the right lobe, measuring 165 × 97 × 156mm, without portal vein thrombosis. Her performance status was 0 and liver function was Child - Pugh class A. She was treated with atezolizumab (1200 mg) plus bevacizumab (15mg/kg) every 3 weeks. After three cycles, the tumor showed near-complete necrosis and achieved a partial response according to mRECIST criteria. The patient subsequently underwent two sessions of super-selective TACE, resulting in further significant tumor shrinkage. To prepare for surgery, right portal vein ligation was performed, leading to an increase in future liver remnant volume from 23% to 47% after 20 days. She then underwent curative right hepatectomy. The postoperative course was uneventful, liver function remained well preserved, and AFP levels returned to within the normal range. Conclusion: Multimodal conversion therapy using atezolizumab–bevacizumab, TACE, PVE, and curative surgery successfully converted an initially unresectable large HCC into a resectable lesion, enabling curative treatment. This case highlights the feasibility and potential benefits of stepwise multimodal strategies for advanced HCC in Viet Nam.