Stereotactic body radiotherapy as the initial treatment for hepatocellular carcinoma with extensive inferior vena cava and atrium tumor thrombus

Hepatocellular carcinoma (HCC) with inferior vena cava (IVC) tumor thrombus rarely occurs, its prognosis is extremely poor. A 49-year-old locally advanced HCC male with tumor thrombus extension into the IVC and the right atrium was successfully treated with stereotactic body radiotherapy (SBRT). A radiation dose of 40 Gy/5 fractions was delivered to the thrombus in 5 days. Contrast-enhanced magnetic resonance imaging one month after SBRT demonstrated no thrombus in IVC and the right atrium, and the huge lesion on right lobe also shrank. No severe adverse effect, eg, pulmonary embolism, was encountered. After controlling the thrombus, this patient has the opportunity to receive subsequent transarterial chemoembolization procedure in time, and avoided disease progression outside the irradiation volume. We reported a HCC case with extensive IVC and atrium tumor thrombus successfully treated by SBRT, the effectiveness and potential severe adverse effects were discussed.