Long-Term Survival in an Elderly HCV Patient with Double Primary Malignant Tumors Managed with Local Therapy Only

Abstract: Hepatitis C virus (HCV) infection is associated with both hepatic and extrahepatic malignancies. We report a 95-year-old male with chronic HCV infection who developed recurrent hepatocellular carcinoma (HCC) and subsequent splenic diffuse large B-cell lymphoma (DLBCL), achieving a 13-year survival. This patient was managed exclusively with local therapies, receiving multiple rounds of radiofrequency ablation (RFA) for five episodes of HCC recurrence and undergoing splenectomy for the primary splenic DLBCL, entirely avoiding systemic chemotherapy. Despite his advanced age and dual primary malignancies, he has maintained normal liver function and shows no evidence of lymphoma progression at the latest follow-up. This case underscores the potential of a patient-centric treatment approach, highlighting that in select very elderly or high-risk patients, aggressive systemic therapy may not be necessary to achieve long-term survival and high quality of life. The successful outcome challenges conventional management paradigms and contributes to the growing evidence supporting minimally invasive, localized interventions for complex oncological scenarios in geriatric populations. It emphasizes the importance of individualized risk-benefit assessment and tumor biology in guiding treatment decisions, offering a new perspective on optimizing outcomes for patients where standard aggressive therapies are contraindicated. Keywords: dual primary malignancy, hepatitis C virus, hepatocellular carcinoma, diffuse large B-cell lymphoma