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Poster display - Cocktail

1439 - A case of obstructive jaundice in hepatocellular carcinoma treated with stereotactic body radiation therapy

Date

24 Nov 2018

Session

Poster display - Cocktail

Presenters

Angela Giselvania

Authors

A. Giselvania, A. Munandar, G.B. Prajogi, S.M. Sekarutami, S. Gondhowiardjo

Author affiliations

  • Radiotherapy, Cipto Mangunkusumo General Hospital (RSCM)/ Universitas Indonesia, 10430 - Jakarta/ID
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Resources

Abstract 1439

Case Summary

A 30-year-old man with obstructive jaundice due to hepatocellular carcinoma (BCLC D Child pugh C) was presented to our department. The patient complained of yellowing of the skin and eyes (icterus), dark urine, nausea, abdominal pain, enlargement of the abdomen, itchiness, and fatigue. The patient also had hepatic cirrhosis, chronic hepatitis B on antiviral treatment. Based on the MR imaging, the patient had solid masses in liver, 17 cm on its largest diameter which caused obstruction of the hepatic bile duct and portal hypertension. Minimal ascites was observed. On laboratory examination, total bilirubin was 33.3 g/dL, direct bilirubin 26.9 g/dL, indirect 6.4 g/dL (two weeks prior to radiation) and dropped to 7.73 g/dL, 6.75 g/dL, and 0.98 g/dL respectively several days before RT; albumin 2.85 g/dL, prothrombin time <4, AFP 368.115 IU/mL and positive HbsAg. On multidisciplinary discussion, it was determined that TACE nor PTBD were not doable during that time. The patient was considered for external beam radiotherapy due to its flexibility of the technical approach. SBRT was consequently done with total dose of 32 Gy in 4 fractions within two weeks. The patient could tolerate the treatment well. On follow up, the liver function gradually became better (Child Pugh A on 2-month evaluation), AFP 32014 UI/mL in 3 month, the mass was slightly decreased in size in 6 month, but had significant central necrotic, and the patient survived for another 10 months with good quality of life (QoL) and died from the complications of lung and brain metastases. SBRT can be an option for obstructive jaundice due to tumor mass with safe and tolerable side effects.

Editorial acknowledgement

Clinical trial identification

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