Liver Resection after Downstaging Hepatocellular Carcinoma with Sorafenib

Abstract EN

Background.

Sorafenib is a molecular-targeted therapy used in palliative treatment of advanced hepatocellular carcinoma in Child A patients.

Aims.

To address the question of sorafenib as neoadjuvant treatment.

Methods.

We describe the cases of 2 patients who had surgery after sorafenib.

Results.

The patients had a large hepatocellular carcinoma in the right liver with venous neoplastic thrombi (1 in the right portal branch, 1 in the right hepatic vein).

After 9 months of sorafenib, reassessment showed that tumours had decreased in size with a necrotic component.

A right hepatectomy with thrombectomy was performed, and histopathology showed 35% to 60% necrosis.

One patient had a recurrence after 6 months and had another liver resection; they are both recurrence-free since then.

Conclusion.

Sorafenib can downstage hepatocellular carcinoma and thus could represent a bridge to surgery.

It may be possible to select patients in good general condition with partial regression of the tumour with sorafenib for a treatment in a curative intent.