Abstract：
OBJECTIVE: We report on a case of locally advanced hepatocellular carcinoma (HCC) accompanied by an inferior vena cava tumor thrombus (IVCTT), treated successfully with proton-beam therapy (PBT).
METHODS: A 63-year-old male presented with a primary, single HCC with IVCTT, without metastasis to the intrahepatic region, lymph nodes, or distant organs. The clinical staging was identified as T4N0M0 Stage IIIB. The patient\'s liver function was classified as Child-Pugh class A (score: 6), with a modified albumin-bilirubin (mALBI) grade of 2a. The patient had liver cirrhosis due to non-alcoholic steatohepatitis. Magnetic resonance imaging revealed a nodular tumor measuring 13.2×8.9×9.8 cm across segments 1, 6, 7, and 8, along with IVCTT. The patient received PBT, with a total dose of 72.6 Gy (relative biological effectiveness) delivered in 22 fractions. Throughout the PBT treatment, the patient experienced no acute toxicities and completed the therapy as planned. Twelve months following PBT, the patient was alive without evidence of local recurrence, lymph node involvement, or distant organ metastasis. The only late toxicity observed was a mild worsening of the mALBI grade.
CONCLUSIONS: We observed a favorable local response with manageable toxicities in a patient with locally advanced HCC and IVCTT treated with PBT. While this is a single case report, our findings suggest that PBT could be considered a viable treatment option for HCC with IVCTT.
METHODS: A 63-year-old male presented with a primary, single HCC with IVCTT, without metastasis to the intrahepatic region, lymph nodes, or distant organs. The clinical staging was identified as T4N0M0 Stage IIIB. The patient\'s liver function was classified as Child-Pugh class A (score: 6), with a modified albumin-bilirubin (mALBI) grade of 2a. The patient had liver cirrhosis due to non-alcoholic steatohepatitis. Magnetic resonance imaging revealed a nodular tumor measuring 13.2×8.9×9.8 cm across segments 1, 6, 7, and 8, along with IVCTT. The patient received PBT, with a total dose of 72.6 Gy (relative biological effectiveness) delivered in 22 fractions. Throughout the PBT treatment, the patient experienced no acute toxicities and completed the therapy as planned. Twelve months following PBT, the patient was alive without evidence of local recurrence, lymph node involvement, or distant organ metastasis. The only late toxicity observed was a mild worsening of the mALBI grade.
CONCLUSIONS: We observed a favorable local response with manageable toxicities in a patient with locally advanced HCC and IVCTT treated with PBT. While this is a single case report, our findings suggest that PBT could be considered a viable treatment option for HCC with IVCTT.
摘要：
目的：我们报告一例局部晚期肝细胞癌（HCC）伴有下腔静脉癌栓（IVCTT），用质子束治疗（PBT）成功治疗。
方法：一名63岁男性，单个肝癌与IVCTT，没有转移到肝内区域，淋巴结,或远处的器官。临床分期确定为T4N0M0IIIB期。患者的肝功能被归类为Child-PughA级（评分：6），改良白蛋白-胆红素（mALBI）等级为2a。该患者因非酒精性脂肪性肝炎而患有肝硬化。磁共振成像显示，结节状肿瘤在第1、6、7和8段以及IVCTT上均为13.2×8.9×9.8cm。病人接受了PBT,总剂量为72.6Gy（相对生物学有效性），分22个部分递送。在整个PBT治疗过程中，患者无急性毒性反应,按计划完成治疗.PBT后12个月，病人还活着，没有局部复发的证据，淋巴结受累,或远处器官转移。观察到的唯一晚期毒性是mALBI等级的轻度恶化。
结论：我们观察到在PBT治疗的局部晚期HCC和IVCTT患者中具有良好的局部反应和可控的毒性。虽然这是一个病例报告,我们的研究结果表明,PBT可被认为是合并IVCTT的HCC的可行治疗选择.
方法：一名63岁男性，单个肝癌与IVCTT，没有转移到肝内区域，淋巴结,或远处的器官。临床分期确定为T4N0M0IIIB期。患者的肝功能被归类为Child-PughA级（评分：6），改良白蛋白-胆红素（mALBI）等级为2a。该患者因非酒精性脂肪性肝炎而患有肝硬化。磁共振成像显示，结节状肿瘤在第1、6、7和8段以及IVCTT上均为13.2×8.9×9.8cm。病人接受了PBT,总剂量为72.6Gy（相对生物学有效性），分22个部分递送。在整个PBT治疗过程中，患者无急性毒性反应,按计划完成治疗.PBT后12个月，病人还活着，没有局部复发的证据，淋巴结受累,或远处器官转移。观察到的唯一晚期毒性是mALBI等级的轻度恶化。
结论：我们观察到在PBT治疗的局部晚期HCC和IVCTT患者中具有良好的局部反应和可控的毒性。虽然这是一个病例报告,我们的研究结果表明,PBT可被认为是合并IVCTT的HCC的可行治疗选择.
