Carbon ion radiotherapy for hepatocellular carcinoma adjacent to the gastrointestinal tract using a spacer: a case report

The history of the use of carbon ion radiotherapy (CIRT) for treating hepatocellular carcinoma (HCC) goes back to 1995, when clinical trials were initiated at the National Institute of Radiological Sciences. We have already reported that CIRT used for the treatment of HCC is safe and effective, and that it causes only minor liver damage. In a phase II clinical trial, the local control and cumulative overall survival rates were 94 % and 35 % at 5 years, respectively. However, the patients with tumor adjacent to the gastrointestinal tract are thought to be ineligible for CIRT because of the high risk of radiation injury of the digestive organs. In order to extend the indication of CIRT, we have challenged the CIRT for such patients under the use of spacers. A case was a 67-year-old female with stage II disease of 8cm in diameter in Segment 4. In radiological findings, the tumor revealed typical enhancement pattern for HCC, and was near the EC junction. She had been judged ineligible for hepatectomy because of the high retention rate of indocyanine green. She could undergo the 42.8 GyE/2-fraction CIRT after the placement of GORE-TEX Soft Tissue Patch under the laparoscopic procedure. Up to the present date, no adverse effect due to the spacer has been occurred, and an apparent anti-tumor effect has been observed. This method seems to have a promising efficacy for extension of the indication of CIRT to the patients with tumors adjacent to the gastrointestinal tract.19th Conference of the Asian Pacific Association for the Study of the Live