Trans-arterial therapy for Fibrolamellar carcinoma: A case report and literature review

M M Bernon; K Gandhi; H Allam; S Singh; J Kloppers; E Jonas

doi:10.1016/j.ijscr.2022.106980

Trans-arterial therapy for Fibrolamellar carcinoma: A case report and literature review

Int J Surg Case Rep. 2022 May:94:106980. doi: 10.1016/j.ijscr.2022.106980. Epub 2022 Mar 29.

Authors

M M Bernon¹, K Gandhi², H Allam³, S Singh⁴, J Kloppers³, E Jonas³

Affiliations

¹ Surgical Gastroenterology Unit, Division of General Surgery, University of Cape Town Health Sciences Faculty and Groote Schuur Hospital, Cape Town, South Africa. Electronic address: mm.bernon@uct.ac.za.
² Department of Surgery, Aga Khan University Hospital, Nairobi, Kenya.
³ Surgical Gastroenterology Unit, Division of General Surgery, University of Cape Town Health Sciences Faculty and Groote Schuur Hospital, Cape Town, South Africa.
⁴ Division of Anatomical Pathology, University of Cape Town Health Sciences Faculty and Groote Schuur Hospital, Cape Town, South Africa.

Abstract

Introduction: Fibrolamellar carcinoma (FLC) is a rare pathologically distinct primary liver cancer. Surgical resection is the only treatment associated with prolonged survival. Trans-arterial embolization (TAE), which is a recognised treatment for hepatocellular carcinoma has been used to treat FLC. We present a case and performed a literature review of patients with FLC treated with TAE.

Case presentation: We present a 19-year old female with a large potentially resectable FLC which was initially treated with trans-arterial chemo-embolization (TACE) with drug eluting beads. The TACE was followed by surgical resection. Histology confirmed tumour necrosis related to the previous TACE.

Discussion & literature review: We identified seven case reports and one case series of TAE for FLC. TAE was either used as a neo-adjuvant therapy to facilitate subsequent tumour resection or as a palliative treatment modality. We propose an algorithm for the treatment of FLC that includes TAE.

Conclusion: The rarity of FLC and the paucity of data precludes establishing clear evidence-based standards of care. We propose an algorithm for the treatment of FLC. The establishment of an international registry may facilitate the collection of better quality evidence.

Keywords: Fibrolamellar carcinoma; Trans-arterial chemo-embolization; Trans-arterial embolization; Trans-arterial radio-embolization.