Figure 4.

Combination of Y-90 SIRT and sorafenib for Barcelona clinic liver cancer stage C hepatocellular carcinoma. This 55-year-old female was treated with chemoembolization at an outside institution and referred with a 14 cm HCC invading the hepatic vein on cross sectional imaging. (A) Demonstrates a small amount of central necrosis including lipiodol from the chemoembolization. (B) Reveals the tumor thrombus extending into the hepatic vein confluence into the right atrium (arrow). She was initiated on sorafenib and referred for intra-arterial therapy at our institution. After performing Y-90 SIRT, there was extensive response with follow-up imaging (C) demonstrating extensive tumor necrosis with minimal residual enhancement and maximal diameter of 10 cm. Y-90, yttrium 90; SIRT, selective internal radiation therapy; HCC, hepatocellular carcinoma.