Two elder cases of hepatocellular carcinoma adjacent to intrahepatic vessels successfully treated by carbon ion radiothe
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CASE REPORT
Two elder cases of hepatocellular carcinoma adjacent to intrahepatic vessels successfully treated by carbon ion radiotherapy Satoshi Takakusagi1 · Hitoshi Takagi1 · Kei Shibuya2 · Takashi Kosone1 · Ken Sato3 · Satoru Kakizaki3 · Tatsuya Ohno2 · Toshio Uraoka3 Received: 24 March 2020 / Accepted: 2 June 2020 © Japanese Society of Gastroenterology 2020
Abstract The treatment for hepatocellular carcinoma (HCC) adjacent to the portal vein and/or bile duct requires considerable caution to avoid the complications, such as hepatic infarction and obstructive jaundice. Carbon ion radiotherapy (CIRT) has been attempted for HCC and has become accepted as a promising modality for minimizing hepatic damage with good local tumor control. We experienced two elder cases of HCC adjacent to intrahepatic vessels successfully treated by CIRT. Case 1, a 75-year-old man, was treated by CIRT for a 2-cm HCC near the porta hepatis adjacent to the right first portal branch. The treatment was sufficiently effective, and no vascular damage was demonstrated after CIRT. The liver function transiently deteriorated after CIRT, but recovered quickly. Alpha-fetoprotein transiently increased after the treatment and decreased thereafter. Tumor stain persisted for 3 months after CIRT, so a liver tumor biopsy was performed. However, no viable carcinoma cells were detected. There was no local recurrence or complications for 17 months. Case 2, 76-year-old male HCC patient, showed dilation of the peripheral bile duct in the left lobe, suggesting tumor invasion to the duct. The tumor was hypovascular and was found to be well-differentiated HCC by a tumor biopsy. He was treated with CIRT, because he had a history of cerebral infarction and was being administered an antiplatelet agent daily. He achieved complete remission, and no adverse events were observed after the treatment for 3 years. Keywords Hepatocellular carcinoma · Carbon ion radiotherapy · Portal vein · Bile duct
Introduction Hepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide and is the fourth leading cause of cancer-related death [1]. Although surgical resection is the most curative treatment for HCC, less than 30% of patients with HCC undergo resection because of an accompanying poor hepatic functional reserve [2, 3] and other * Hitoshi Takagi htakagi@kusunoki‑hp.com * Satoru Kakizaki kakizaki@gunma‑u.ac.jp 1
Department of Gastroenterology and Hepatology, Kusunoki Hospital, 607‑22 Fujioka, Fujioka, Gunma 375‑0024, Japan
2
Gunma University Heavy Ion Medical Center, 3‑39‑22 Showa‑machi, Maebashi, Gunma 371‑8511, Japan
3
Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, 3‑39‑15 Showa‑machi, Maebashi, Gunma 371‑8511, Japan
complications. In addition, HCC frequently recurs after treatment and occurs in elderly patients with an impaired physical condition. Liver transplantation is another curative treatment for HCC, but it is not always feasible because of the shortage of donors. In contrast, r
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