Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Oct 27, 2018; 10(10): 772-779
Published online Oct 27, 2018. doi: 10.4254/wjh.v10.i10.772
Proton beam therapy in apneic oxygenation treatment of an unresectable hepatocellular carcinoma: A case report and review of literature
Yi-Lan Lin
Yi-Lan Lin, Department of Radiation Oncology, Rinecker Proton Therapy Center, Munich 81371, Germany
Author contributions: Lin YL performed all research and interpretive functions for this case report.
Supported by Rinecker Proton Therapy Center (RPTC), Munich, Germany.
Informed consent statement: After contacting the patient about the planned publication of his case, he provided written authorization.
Conflict-of-interest statement: The author states there are no potential conflicts of interest relevant to this publication.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yi-Lan Lin, MD, Chief Doctor, Department of Radiation Oncology, Rinecker Proton Therapy Center, Schaeftlarnstr 133, Munich 81371, Germany. yi-lan.lin@rptc-1.de
Telephone: +49-89-724670 Fax: +49-89-72467352
Received: April 5, 2018
Peer-review started: April 6, 2018
First decision: May 16, 2018
Revised: June 14, 2018
Accepted: June 27, 2018
Article in press: June 28, 2018
Published online: October 27, 2018
Processing time: 205 Days and 15.8 Hours
Abstract

Presented here is the clinical course of a 63-year-old patient with a central, large and unresectable hepatocellular carcinoma (HCC) with liver metastases and tumor invasion of the portal and hepatic veins. After the tumor had been diagnosed, the patient was immediately treated with proton beam therapy (PBT), at a total dose of 60 Gy (relative biological effectiveness) in 20 fractions administered within 4 wk. To manage the respiratory movements, at the Rinecker Proton Therapy Center, apneic oxygenation was given daily, under general anesthesia. The patient tolerated both the PBT and general anesthesia very well, and did now show any signs of acute or late toxicity. The treatment was followed by constant reductions in the tumor marker alpha-fetoprotein and the cholestatic parameters gamma-glutamyltransferase and alkaline phosphatase. The patient commenced an adjuvant treatment with sorafenib, given at 6-wk intervals, after the PBT. Follow-up with regular magnetic resonance imaging has continued for 40 mo so far, demonstrating remarkable shrinkage of the HCC (maximal diameter dropping from approximately 13 cm to 2 cm). To date, the patient remains free of tumor recurrence. PBT served as a safe and effective treatment method for an unresectable HCC with vascular invasion.

Keywords: Particle therapy; Proton beam therapy; Apneic oxygenation; Unresectable; Vascular invasion; Hepatocellular carcinoma; Intrahepatic metastasis

Core tip: Hepatocellular carcinoma (HCC) is one of the most common cancers in Asia. Patients with unresectable tumor disease require more options for in-principle curative therapies. We report here a patient with a large unresectable HCC due to vascular invasion and satellite metastases, who showed remarkable tumor shrinkage after completing proton beam therapy 4 years ago and who is still free of tumor recurrence to date.