case_images: PMC11137744_01
case_images: Panel (A) is the CT image of the liver before the first FOLFOX-HAIC, and panel B is the DSA image of the first FOLFOX-HAIC, both of which can see massive masses in the right lobe of the liver, multiple nodules in the liver, and apparent tumor staining. Panel (E) is the first efficacy assessment after three FOLFOX-HAIC treatments combined with Lenvatinib and Sintilimab. CT examination showed mild circular enhancement of giant tumors in the right lobe of the liver in the arterial stage, and some nodular lesions in the liver were mildly enhanced, but no new lesions were detected. Panel (F) is the DSA image of the fourth FOLFOX-HAIC, as shown in panel (E). In contrast to panel (B), the hepatic artery vessels (black arrow) become thinner, the volume of the tumor (red arrow) in the right lobe of the liver is significantly reduced, and the tumor staining is reduced considerably, which can reach partial response (PR) according to Response Evaluation Criteria in Solid Tumors (RECIST) v1.1. Panel (H) is the second evaluation of the efficacy after five FOLFOX-HAIC treatments combined with Lenvatinib and Sintilimab. A liver MRI examination showed fine line enhancement in the liver at the arterial stage, liquefaction necrosis in the original lesion area, and no new lesions. Panel (I) shows the angiography before removing the artery infusion port, where no noticeable tumor staining was observed. Compared with panel (F), the blood vessels (black arrow) in the right lobe of the liver are further narrowed, and the volume of the masses (red arrow) in the right lobe of the liver is significantly slightly reduced, up to complete response (CR), and continued until the latest review.
case_images: fonc-14-1401882-g001.jpg
case_images: PMC11137744_01_fonc-14-1401882-g001.jpg
case_images: f1
case_images: The chronological progression of the entire case is illustrated in  Figure 1 . As seen from the DSA images in  Figures 1B-D , hepatic artery vessels (black arrow) gradually became thinner and more apparent, intrahepatic lesion staining decreased significantly, and lesion volume (red arrow) decreased significantly. Partial tumor staining was still visible in  Figure 1D . As shown in  Figures 1F, G , hepatic arteriography sessions were conducted in February and March 2022, respectively, which revealed a successive decline in tumor staining and blood supply (red arrow), with blood vessels (black arrow) supplying the tumor, becoming thinner. AFP were in the normal range, as shown in  Table 1 ;  Figure 3 , red blood cells and white blood cells were in the normal range, liver function was good, and coagulation function was normal. As shown in  Figure 1H , Liver-enhanced magnetic resonance imaging (MRI) showed fine line enhancement within the lesion, demonstrating a reduced lesion area compared to the CT examination conducted in February 2022.
case_images: Comparison of DSA images before and after treatment and implantation of an arterial infusion port. Panel (A) is the image of the initial contrast. Large lesions in the right lobe of the liver and scattered lesions in the liver can be seen. Blood is supplied by the left hepatic artery (thin black arrow) and the right hepatic artery (thick black arrow), and the initial segment of the gastroduodenal artery (red arrow) can be seen. Panel (B) shows the position of the tip of the intrahepatic catheter at the port of arterial infusion (black arrow). In order to alleviate the adverse reactions after infusion, the gastroduodenal artery was selectively embolized with a spring ring (red arrow). Panel (C) shows the location and shape of the arterial infusion port (red circle). Panel (D) is the sixth contrast image. Compared with panel (A), the left hepatic artery (thin black arrow) and the right hepatic artery (thick black arrow) were significantly thinner, and the tumor staining disappeared.
case_images: fonc-14-1401882-g002.jpg
case_images: PMC11137744_01_fonc-14-1401882-g002.jpg
case_images: f2
case_images: The imaging revealed extensive lesions in the right liver lobe and multiple intrahepatic lesions supplied by both the left and right hepatic arteries, as shown in  Figure 2 . On 24 May 2022, liver arteriography indicated the disappearance of tumor staining with no emergence of new lesions, as shown in  Figure 2 .
case_images: Line chart of serum PIVKA-II.
case_images: fonc-14-1401882-g003.jpg
case_images: PMC11137744_01_fonc-14-1401882-g003.jpg
case_images: f3
case_images: AFP were in the normal range, as shown in  Table 1 ;  Figure 3 , red blood cells and white blood cells were in the normal range, liver function was good, and coagulation function was normal. As shown in  Figure 1H , Liver-enhanced magnetic resonance imaging (MRI) showed fine line enhancement within the lesion, demonstrating a reduced lesion area compared to the CT examination conducted in February 2022.