Patient A
The first patient, an 82-year-old male, was referred to our hospital for the treatment of a solitary liver tumor. He was transferred from another hospital where he was analyzed for abdominal pain and weight loss. Ultrasound revealed a large tumor in the right lobe of the liver. The serum level of alpha-fetoprotein (AFP) was elevated; 59 µg/L. Magnetic resonance imaging (MRI) demonstrated a tumor of 10 cm in diameter in liver segments 5, 7 and 8. There was no history of excessive alcohol intake. Screening blood tests for causal factors of HCC, including hepatitis B and C, were negative. Because of inconclusive imaging results, a histologic biopsy was taken and demonstrated a typical HCC in a normal, non-cirrhotic liver. The patient refused extensive surgical resection and declined palliative systemic therapy for HCC. To reduce his abdominal complaints, he started using cannabis oil containing 10% delta-9-tetrahydrocannabinol (THC) and 5% cannabidiol (CBD), two droplets sublingually three times daily. He did not experience any side effects.
At the first follow-up after 6 months, his abdominal complaints had resolved, and AFP levels were normalized to 2 µg/L. MRI demonstrated regression of the tumor to a size of 5,1 cm. The patient continued the use of cannabis oil, and the tumor continued reducing in size. Approximately two years after the diagnosis, the tumor was undetectable on MRI (Fig. 1A-C). Until today, almost 8 years after diagnosis, the tumor has not been detected again on imaging studies and AFP levels have remained normal.
Patient B
The second patient, a 77-year-old male was referred to our hospital with undesired weight loss, a liver mass detected on ultrasound, and an AFP of 40,950 µg/L. He had a history of alcohol abuse. Screening blood tests for other causal factors of HCC, including hepatitis B and C, were negative. Computed tomography (CT) studies demonstrated a large tumor of 15,6 cm with central necrosis in liver segments 6, 7 and 8. A second lesion of 2,5 cm was located in segment 5. HCC was diagnosed based on typical imaging characteristics (arterial enhancement with wash-out in the late phase) combined with highly elevated levels of AFP and des-gamma carboxyprothrombin (22,142 AU/L).[1] Both tumors were deemed unresectable and the patient refused palliative treatment options for HCC, including selective internal radiotherapy (SIRT). In order to improve appetite and gain weight, he started to use cannabis oil (15% THC and 2% CBD), 5 droplets sublingually two times daily. He did not experience any side effects.
After 3 months follow-up, his clinical condition had improved, and he had gained weight. Upon imaging, the tumors had reduced in size from 15,6 to 9,2 cm in diameter and 2,5 to 1,9 cm, respectively. Afterwards, he continued to use cannabis oil and approximately 15 months after diagnosis the AFP had normalized to 2 µg/L. On CT, no vital tumor tissue was visible anymore, only rest necrosis (Fig. 1D-F). To this day, almost 5 years after diagnosis, imaging studies do not demonstrate any recurrent disease and AFP levels are normal.