Sequential Multimodal Therapy for Conversion Resection of Stage IIIa Hepatocellular Carcinoma: A Case Report.

Abstract

Objective: To explore the feasibility and clinical value of conversion resection after sequential comprehensive therapy consisting of transarterial chemoembolization (TACE), targeted therapy, immunotherapy and radiotherapy in patients with initially advanced stage IIIa hepatocellular carcinoma (HCC).

Methods: The clinical data of a 61-year-old male patient with massive stage IIIa HCC accompanied by right portal vein tumor thrombus were retrospectively analyzed. The maximum diameter of the primary tumor was approximately 10.0 cm at initial diagnosis. The patient received sequential combination therapy of TACE plus targeted-immunotherapy for 8 months, followed by liver tumor radiotherapy about 1 month and maintenance targeted-immunotherapy for 12 months. After sustained tumor shrinkage, radical resection was performed on March 13, 2026.

Results: Following sequential multimodal treatment, the maximum tumor diameter decreased from 10.0 cm to 4.0 cm × 3.6 cm, achieving partial response (PR). The tumor was successfully downstaged to resectable status, and the patient recovered smoothly postoperatively without severe complications.

Conclusion: Sequential comprehensive therapy combining TACE, targeted-immunotherapy and radiotherapy can significantly downstage initially advanced stage IIIa HCC, create opportunities for curative resection, and potentially improve long-term prognosis of patients.