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Case Reports
. 2021 Feb 3:27:152-156.
doi: 10.1016/j.ctro.2021.01.014. eCollection 2021 Mar.

Proton beam therapy for a giant hepatic hemangioma: A case report and literature review

Shosei Shimizu  1 , Masashi Mizumoto  1 , Toshiyuki Okumura  1 , Yinuo Li  2 , Keiichirou Baba  1 , Motohiro Murakami  1 , Toshiki Ishida  1 , Masatoshi Nakamura  1 , Yuichi Hiroshima  1 , Takashi Iizumi  1 , Takashi Saito  1 , Haruko Numajiri  1 , Kei Nakai  1 , Masaharu Hata  3 , Hideyuki Sakurai  1
Affiliations
Case Reports

Proton beam therapy for a giant hepatic hemangioma: A case report and literature review

Shosei Shimizu et al. Clin Transl Radiat Oncol. .

Abstract

Background: Hepatic hemangiomas are benign tumors with a favorable prognosis, but giant hepatic hemangiomas can cause abdominal symptoms and are indicated for treatment. Most cases are treated with surgery, but radiotherapy has also been used. However, to date, there have been no reports of proton beam therapy for a hepatic hemangioma.

Case presentation: A 46-year-old woman had a tumor of 80 × 80 mm in the left medial lobe of the liver, which was diagnosed as a giant hemangioma based on the contrast pattern. Therapy was required for a giant hepatic hemangioma with symptoms, but the patient refused blood transfusion due to religious reasons, which made surgical resection difficult. Therefore, she was referred to our hospital for proton beam therapy. At her first visit, liver function was Child-Pugh A (5 points) and there was no elevation of tumor markers. Proton beam therapy of 28.6 Gy (RBE) given in 13 fractions was performed without interruption. The only observed acute radiation toxicity was Grade 1 dermatitis. One year after proton beam therapy, the hemangioma had significantly decreased, and a complete response has been maintained for 15 years based on ultrasound and MRI.

Conclusion: This case is the first reported use of proton beam therapy for a hepatic hemangioma. The outcome suggests that this treatment may be effective for a giant liver hemangioma.

Keywords: Hemangioma; Liver; Proton beam therapy; Radiotherapy; Secondary cancer.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Dose-distribution chart for proton beam therapy, showing isodose curves representing 100% to 10% of the prescribed dose at 10% intervals. Normal liver outside the blue line was not irradiated. The treatment plan was changed after ten rounds to gradually reduce the treatment margin. (a) 0–22 Gy (RBE)/10 Fr. (b) 24.2–28.6 Gy (RBE)/11–13 Fr. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)
Fig. 2
Fig. 2
CT showed a giant hepatic hemangioma in the left medial lobe before proton beam therapy. (a) Hepatoarterial phase (b) Portal venous phase (c) Equilibrium phase.
Fig. 3
Fig. 3
T2-weighted MRI showed that the size of the giant hepatic hemangioma had reduced to 29 × 15 mm and maintained for 15 years after proton beam therapy.
See this image and copyright information in PMC

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