Hepatocellular carcinoma tumor thrombus entering the right atrium treated with combining percutaneous and intravenous high-dose-rate brachytherapy: a case report

Fig. 1. Pre-interventional imaging of the TT in the RA. (A) Pre-interventional axial CT-angiography showing extensive growth of the TT in the RA and confirming arterial enhancement in the TT. (B) Pre-interventional echocardiogram confirming a mass in the RA

Fig. 2. Pre- and post-interventional radiographic images. (A) Pre-interventional contrast enhanced MRI examination in the hepatobiliary excretion phase showing a large tumor lesion in segment IV/VIII in transversal plane. (B) six-months post-interventional MRI showing good radiological response to treatment using the same imaging technique. (C) Pre-interventional contrast enhanced CT examination confirms the presence of a TT entering the middle liver vein and extending through the IVC into the RA of the heart in the coronal plane. (D) six-months post-interventional CT showing marked shrinkage of the TT improving blood flow to the heart using the same imaging technique

Fig. 3. Peri-interventional 3D-irradiation plan. Contrast-enhanced planning computed tomography (CT) after CT-guided positioning of two afterloading catheters. Orange marker shows transcutaneous catheter 1, green marker shows transfemoral catheter 2. Visible tumour borders were defined as the clinical target volume (CTV) (blue line). Dose distribution was adjusted by 3D-treatment planning. The planned minimal enclosing dose was 15 Gy (blue line). Isodose irradiation lines surround the CTV