{"id":1870,"date":"2009-10-01T01:00:00","date_gmt":"2009-10-01T00:00:00","guid":{"rendered":"https:\/\/angh.net\/abstracts\/carcinome-hepatocellulaire-avec-thrombose-portale-partielle-reduction-tumorale-sous-sorafenib-suivie-d-hepatectomie-droite\/"},"modified":"2018-10-20T18:39:51","modified_gmt":"2018-10-20T16:39:51","slug":"carcinome-hepatocellulaire-avec-thrombose-portale-partielle-reduction-tumorale-sous-sorafenib-suivie-d-hepatectomie-droite","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/carcinome-hepatocellulaire-avec-thrombose-portale-partielle-reduction-tumorale-sous-sorafenib-suivie-d-hepatectomie-droite\/","title":{"rendered":"Carcinome h\u00e9patocellulaire avec thrombose portale partielle. R\u00e9duction tumorale sous sorafenib suivie d\u2019 h\u00e9patectomie droite."},"content":{"rendered":"<p><strong>2009<\/strong><\/p>\n<p><em>Louise Barbier (1), Le\u00efla Kanafi (2),  Sophie Leguellec (3), Bertrand Suc (1), Philippe Otal (4) , Alexandre Pariente (2).(1) Service de Chirurgie Digestive, (3) Service d\u2019 anatomie et de cytologie pathologiques, (4) Service d\u2019 Imagerie M\u00e9dicale,CHU Rangueil, Toulouse, (2) Unit\u00e9 d\u2019 HGE, Centre Hospitalier de Pau<\/em><\/p>\n<p><strong>H\u00e9patologie <\/strong>&#8211; \u00a02009-06-21 &#8211;\u00a0PW &#8211;<\/p>\n<p>________________________________<\/p>\n<p>L\u2019 utilisation n\u00e9oajuvante du sorafenib n\u2019 a pas \u00e9t\u00e9 rapport\u00e9e.<br \/>\nUn homme de 55 ans \u00e9tait hospitalis\u00e9 en Juin 2008 pour une h\u00e9patom\u00e9galie douloureuse apparue en 2 mois. Il n&rsquo; avait pas d&rsquo; ant\u00e9c\u00e9dent notable, un tabagisme \u00e0 40 p\/a, une consommation d&rsquo; alcool de 100 g\/j depuis 2004. Il avait maigri de 8 kg.L&rsquo; examen montrait un gros foie douloureux, et de nombreux angiomes stellaires. Hb 20 g\/dL, VGM 99 fl, Hte 66%, 277.000 plaquettes\/\u00b5L, TP 79%, , bilirubine 43 \u00b5Mol, AST 161 UI\/L,  ALT 96, GGT 676 (49), calc\u00e9mie  , albumine 33 g\/L, &#61537;foetoprot\u00e9ine 453.500 ng\/mL. AgHBs absent, antiVHC pr\u00e9sent, ARN VHC 6.6 log UI\/mL, g\u00e9notype 3a. Scanner et IRM : volumineuse tumeur faite de gros nodules confluents occupant la majeure partie du foie droit, thrombose totale de la branche portale D, et thrombus bombant dans la lumi\u00e8re de la bifurcation portale. Pas de varice oesophagienne. Traitement : sorafenib 800 mg\/j,antalgiques,10 saign\u00e9es jusqu&rsquo; au 20 juillet 2008,. En Octobre 2008, pas de douleur. Bilirubine 13 \u00b5M, &#61537;foetoprot\u00e9ine 8950 ng\/mL; IRM: diminution de 25% de la l\u00e9sion principale. Biopsie du foie gauche : M\u00e9tavir A1F1. F\u00e9vrier 2009: pas de sympt\u00f4me. &#61537;foetoprot\u00e9ine 13.038 ng\/mL. IRM : stabilit\u00e9 l\u00e9sionnelle. Bilan d&rsquo; extension n\u00e9gatif. H\u00e9patectomie droite, avec r\u00e9section partielle de la veine porte le 14 Avril 2009. Histopathologie : Carcinome h\u00e9patocellulaire mixte moyennement diff\u00e9renci\u00e9 largement n\u00e9cros\u00e9; le \u00ab\u00a0thrombus\u00a0\u00bb portal \u00e9tait enti\u00e8rement n\u00e9crotique. Suites simples (ascite mod\u00e9r\u00e9e post op\u00e9ratoire). Le 16 Juin 2009: examen clinique normal, Hb 12 g\/dL, bilirubine 11 \u00b5M, tests h\u00e9patiques normaux, &#61537;foetoprot\u00e9ine 65 ng \/mL, scanner normal.<br \/>\nLe sorafenib est actuellement indiqu\u00e9 dans le traitement du carcinome h\u00e9patocellulaire chez les malades Child A, OMS 0-2, dont la tumeur n&rsquo; est pas traitable par d&rsquo; autres moyens. Chez ces patients, le traitement augmente significativement la m\u00e9diane de survie (de 7,9 \u00e0 10,7 mois) et la survie sans progression (5,5 vs 2,8 mois). Le taux de r\u00e9ponse morphologique \u00ab\u00a0classique\u00a0\u00bb n&rsquo; est que de 2,4%, mais des n\u00e9croses tumorales importantes sont possibles. Plus que l&rsquo; hypervascularisation art\u00e9rielle, la diminution de l&rsquo; activit\u00e9 mesurable au TEPscan au 18Fd\u00e9soxyglucose pourrait pr\u00e9dire la r\u00e9ponse tumorale. <\/p>\n<p>Llovet JM et al. N Engl J Med 2008;359:378.<br \/>\nSiemerink EJM et al, The Oncologist 2008;13:734\u2013735<\/p>\n","protected":false},"excerpt":{"rendered":"<p>2009 Louise Barbier (1), Le\u00efla Kanafi (2), Sophie Leguellec (3), Bertrand Suc (1), Philippe Otal (4) , Alexandre Pariente (2).(1) Service de Chirurgie Digestive, (3) Service d\u2019 anatomie et de cytologie pathologiques, (4) Service d\u2019 Imagerie M\u00e9dicale,CHU Rangueil, Toulouse, (2) Unit\u00e9 d\u2019 HGE, Centre Hospitalier de Pau H\u00e9patologie &#8211; \u00a02009-06-21 &#8211;\u00a0PW &#8211; ________________________________ L\u2019 utilisation [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[3],"tags":[20],"class_list":["post-1870","post","type-post","status-publish","format-standard","hentry","category-hepatologie","tag-20"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Carcinome h\u00e9patocellulaire avec thrombose portale partielle. 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