PMC3830515_01
Contrast-enhanced CT scan of the liver performed as baseline assessment in March 2012 (A and B), at the end of June 2012 (C and D), and in January 2013, showing a progressive shrinkage of the the large HCC lesion of the right lobe. A, C, and E panels: arterial phase. B, D, and F panels: equilibrium phase. Note that the HCC lesion detected in the segment II (arrows in panels A and B) was also markedly reduced at the first CT control (C and D), and was no longer clearly distinguishable from the surrounding tissue at the last radiologic control (E and F).
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fig5799
The major lesion had increased to 90 mm x 87 mm, with persistent high vascularization, and involved the corresponding segmentary portal vessel (Figure 1, A and B). CT scan showed size reduction of the major lesion to 75 mm x 72 mm with hypodense necrotic areas (Figure 1, C and D), the persistence of three subcentimetric lesions, and the complete disappearance of the other four lesions. Capecitabine was continued and, after a further dose reduction to 150 mg twice daily due to a transient reappareance of grade 2 HFS which required one week interruption, was well tollerated. The last contrast-enhanced CT assessments showed further decrease of the tumor, with the major lesion decreased to 43 mm x 39 mm in October 2012, and to 39 mm x 39 mm in January 2013 (Figure 1, E and F).
PMC3830515_02
Contrast-enhanced CT scan of the liver performed in December 2011, as baseline assessment, showing the large HCC lesion of the right lobe including a necrotic component (A and B), a small satellite lesion (arrow in panel A), and the lesion in segment VIII (arrow in panel E). A, C, E, and G panels: arterial phase. B, D, F, and H panels: equilibrium phase.. The last contrast-enhanced CT scan performed in January 2013 showed a reduction in vascularity of the large lesion with an increase of tumor necrosis, and a significant shrinkage of the satellite lesion (C and D). The lesion in segment VIII was no longer clearly distinguishable from the surrounding tissue (G and H).
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fig5800
CT scan that showed a lesion in segment VI of 111 mm x 95 mm with a small adjacent satellite lesion, and other three lesions with a maximum diameter of 22 mm (segment I), 25 mm (segment VIII), and 24 mm (segment IV) (Figure 2, A, B, E, F). Due to the multifocal HCC with a high risk of bleeding and spontaneous rupture of the major lesion, we judged the patient not eligible for endovascular or sorafenib treatment. Considering the absence of chronic liver disease, and the good clinical conditions (ECOG Performance status 0), we proposed an off label treatment with metronomic capecitabine at the dose of 500 mg thrice daily. The last control CT scan of January 2013 showed an increase of necrotic area within the largest lesion (Figure 2, C and D). The lesion of the segment VIII (Figure 2, G and H), after a reduction in size over the time, was no longer distinguishable from the surrounding tissue.