PDF(Pubmed)
Abstract：
Numerous potentially curative treatments have become available for patients with hepatocellular carcinoma (HCC) on the basis of the individual patient and tumor characteristics. Carbon-ion radiotherapy (C-ion RT) is a novel treatment option to reduce the physical burden in patients with HCC. However, the long-term outcomes and the clinical and pathological features of locoregional recurrence after initial C-ion RT are unclear. The present study reports the case of a patient who underwent a curative laparoscopic liver resection for the local recurrence of HCC after C-ion RT. A 73-year-old man was diagnosed with chronic hepatitis C and achieved a sustained virological response. During subsequent surveillance, a solitary HCC of 2.3 cm in diameter appeared in liver segment 7 (S7). While surgical resection was considered the best option, the patient chose C-ion RT as the initial HCC treatment. Although C-ion RT appeared to be successful for the primary lesion, enhanced computed tomography revealed that a hypervascular tumor had reappeared in the same area 16 months later. As HCC recurrence was suspected, several different examinations were performed. Computed tomography and magnetic resonance imaging showed that the recurrent tumor had irregular margins, and communication was suspected with the intrahepatic portal vein. A laparoscopic partial liver resection of S7 was planned. Histopathological examination of the excised specimen revealed proliferation of viable moderately to poorly differentiated HCC, with marked invasive growth and numerous portal vein infiltrations. To the best of our knowledge, this is the first report of surgery for locally recurrent HCC after C-ion RT. Oncological outcomes following C-ion RT for HCC remain unclear. Notably, there are cases of unusual recurrence with massive vascular invasion after C-ion RT. In the present case, the histological features were confirmed after C-ion RT for HCC. This case may raise concerns about the true efficacy of C-ion RT and warns against the easy choice of C-ion RT in spite of a resectable HCC.
摘要：
根据个体患者和肿瘤特征，许多潜在的治愈性治疗方法已可用于肝细胞癌（HCC）患者。碳离子放疗（C-离子RT）是一种新的治疗选择，以减轻肝癌患者的身体负担。然而,初次C-离子RT后局部复发的长期结局以及临床和病理特征尚不清楚.本研究报告了一例因C-ionRT后局部复发而接受根治性腹腔镜肝切除术的患者。一名73岁的男子被诊断出患有慢性丙型肝炎，并获得了持续的病毒学应答。在随后的监视中,肝7段（S7）出现直径为2.3cm的孤立性HCC。虽然手术切除被认为是最好的选择，患者选择C-离子RT作为初始HCC治疗。尽管C-离子RT似乎对原发病变成功，增强计算机断层扫描显示，16个月后，在同一区域再次出现了高血管肿瘤。由于怀疑HCC复发，进行了几种不同的检查.计算机断层扫描和磁共振成像显示，复发的肿瘤边缘不规则，怀疑与肝内门静脉的沟通。计划进行S7的腹腔镜部分肝切除术。切除标本的组织病理学检查显示有活力的中度至低分化HCC增殖，有明显的侵袭性生长和大量门静脉浸润。据我们所知,这是C-ionRT后局部复发HCC的首次手术报告。C-ionRT治疗HCC后的肿瘤学结果尚不清楚。值得注意的是,C-ionRT后有异常复发伴大量血管浸润的病例。在目前的情况下,在C-离子RT治疗HCC后证实了组织学特征。这种情况可能会引起人们对C-离子RT的真正功效的担忧，并警告尽管可切除的HCC但易于选择C-离子RT。
