Laparoscopic liver resection for local recurrence after carbon‑ion radiotherapy for hepatocellular carcinoma: A case report

Tanaka,Tomokazu; Ide,Takao; Itoh,Kotaro; Kai,Keita; Noshiro,Hirokazu

doi:10.3892/ol.2023.14211

Laparoscopic liver resection for local recurrence after carbon‑ion radiotherapy for hepatocellular carcinoma: A case report

Authors:
- Tomokazu Tanaka
- Takao Ide
- Kotaro Itoh
- Keita Kai
- Hirokazu Noshiro
View Affiliations

Affiliations: Department of Surgery, Faculty of Medicine, Saga University, Saga 849‑8501, Japan, Department of Pathology, Faculty of Medicine, Saga University, Saga 849‑8501, Japan
Published online on: December 28, 2023 https://doi.org/10.3892/ol.2023.14211
Article Number: 78
Copyright: © Tanaka et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

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.

View Figures

View References

1	Hasegawa K, Takemura N, Yamashita T, Watadani T, Kaibori M, Kubo S, Shimada M, Nagano H, Hatano E, Aikata H, et al: Clinical practice guidelines for hepatocellular carcinoma: The Japan society of hepatology 2021 version (5th JSH-HCC guidelines). Hepatol Res. 53:383–390. 2023. View Article : Google Scholar : PubMed/NCBI
2	Reig M, Forner A, Rimola J, Ferrer-Fàbrega J, Burrel M, Garcia-Criado Á, Kelley RK, Galle PR, Mazzaferro V, Salem R, et al: BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update. J Hepatol. 76:681–693. 2022. View Article : Google Scholar : PubMed/NCBI
3	Bush DA, Smith JC, Slater JD, Volk ML, Reeves ME, Cheng J, Grove R and de Vera ME: Randomized clinical trial comparing proton beam radiation therapy with transarterial chemoembolization for hepatocellular carcinoma: Results of an interim analysis. Int J Radiat Oncol Biol Phys. 95:477–482. 2016. View Article : Google Scholar : PubMed/NCBI
4	Kim TH, Koh YH, Kim BH, Kim MJ, Lee JH, Park B and Park JW: Proton beam radiotherapy vs. radiofrequency ablation for recurrent hepatocellular carcinoma: A randomized phase III trial. J Hepatol. 74:603–612. 2021. View Article : Google Scholar : PubMed/NCBI
5	Hara K, Takeda A, Tsurugai Y, Saigusa Y, Sanuki N, Eriguchi T, Maeda S, Tanaka K and Numata K: Radiotherapy for hepatocellular carcinoma results in comparable survival to radiofrequency ablation: A propensity score analysis. Hepatology. 69:2533–2545. 2019. View Article : Google Scholar : PubMed/NCBI
6	Kim N, Cheng J, Jung I, Liang J, Shih YL, Huang WY, Kimura T, Lee VHF, Zeng ZC, Zhenggan R, et al: Stereotactic body radiation therapy vs. radiofrequency ablation in Asian patients with hepatocellular carcinoma. J Hepatol. 73:121–129. 2020. View Article : Google Scholar : PubMed/NCBI
7	Shiba S, Shibuya K, Katoh H, Kaminuma T, Miyazaki M, Kakizaki S, Shirabe K, Ohno T and Nakano T: A comparison of carbon ion radiotherapy and transarterial chemoembolization treatment outcomes for single hepatocellular carcinoma: A propensity score matching study. Radiat Oncol. 14:1372019. View Article : Google Scholar : PubMed/NCBI
8	Brierley J, Gospodarowicz MK and Wittekind Ch: TNM Classification of Malignant Tumours. 8th edition. John Wiley & Sons, Inc.; Hoboken, NJ: pp. 106–112. 2017
9	Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC and Williams R: Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 60:646–649. 1973. View Article : Google Scholar : PubMed/NCBI
10	Johnson PJ, Berhane S, Kagebayashi C, Satomura S, Teng M, Reeves HL, O'Beirne J, Fox R, Skowronska A, Palmer D, et al: Assessment of liver function in patients with hepatocellular carcinoma: A new evidence-based approach-the ALBI grade. J Clin Oncol. 33:550–558. 2015. View Article : Google Scholar : PubMed/NCBI
11	Shibuya K, Ohno T, Katoh H, Okamoto M, Shiba S, Koyama Y, Kakizaki S, Shirabe K and Nakano T: A feasibility study of high dose hypofractionated carbon ion radiation therapy using four fractions for localized hepatocellular carcinoma measuring 3 cm or larger. Radiother Oncol. 132:230–235. 2019. View Article : Google Scholar : PubMed/NCBI
12	Kasuya G, Kato H, Yasuda S, Tsuji H, Yamada S, Haruyama Y, Kobashi G, Ebner DK, Okada NN, Makishima H, et al: Progressive hypofractionated carbon-ion radiotherapy for hepatocellular carcinoma: Combined analyses of 2 prospective trials. Cancer. 123:3955–3965. 2017. View Article : Google Scholar : PubMed/NCBI
13	Kato H, Tsujii H, Miyamoto T, Mizoe JE, Kamada T, Tsuji H, Yamada S, Kandatsu S, Yoshikawa K, Obata T, et al: Results of the first prospective study of carbon ion radiotherapy for hepatocellular carcinoma with liver cirrhosis. Int J Radiat Oncol Biol Phys. 59:1468–1476. 2004. View Article : Google Scholar : PubMed/NCBI
14	Abe T, Saitoh J, Kobayashi D, Shibuya K, Koyama Y, Shimada H, Shirai K, Ohno T and Nakano T: Dosimetric comparison of carbon ion radiotherapy and stereotactic body radiotherapy with photon beams for the treatment of hepatocellular carcinoma. Radiat Oncol. 10:1872015. View Article : Google Scholar : PubMed/NCBI
15	Shiba S, Shibuya K, Kawashima M, Okano N, Kaminuma T, Okamoto M, Kubota Y, Nakano T and Ohno T: Comparison of dose distributions when using carbon ion radiotherapy versus intensity modulated radiotherapy for hepatocellular carcinoma with macroscopic vascular invasion: A retrospective analysis. Anticancer Res. 40:459–464. 2020. View Article : Google Scholar : PubMed/NCBI
16	Shiba S, Abe T, Shibuya K, Katoh H, Koyama Y, Shimada H, Kakizaki S, Shirabe K, Kuwano H, Ohno T and Nakano T: Carbon ion radiotherapy for 80 years or older patients with hepatocellular carcinoma. BMC Cancer. 17:7212017. View Article : Google Scholar : PubMed/NCBI
17	Shiba S, Shibuya K, Katoh H, Koyama Y, Okamoto M, Abe T, Ohno T and Nakano T: No deterioration in clinical outcomes of carbon ion radiotherapy for sarcopenia patients with hepatocellular carcinoma. Anticancer Res. 38:3579–3586. 2018. View Article : Google Scholar : PubMed/NCBI
18	Huang Y, Hidaka M, Takatsuki M, Soyama A, Adachi T, Ono S, Kugiyama T, Hara T, Okada S, Yoshimoto T, et al: Surgical findings and technical knacks to performing living donor liver transplantation for hepatocellular carcinoma recurrence after carbon ion radiotherapy. J Surg Case Rep. 2018:rjy2282018. View Article : Google Scholar : PubMed/NCBI
19	Kojiro M and Nakashima O: Histopathologic evaluation of hepatocellular carcinoma with special reference to small early stage tumors. Semin Liver Dis. 19:287–296. 1999. View Article : Google Scholar : PubMed/NCBI
20	Maeda T, Takenaka K, Taguchi K, Kajiyama K, Shirabe K, Shimada M, Tsuneyoshi M and Sugimachi K: Clinicopathological characteristics of surgically resected minute hepatocellular carcinomas. Hepatogastroenterology. 47:498–503. 2000.PubMed/NCBI
21	Nakashima Y, Nakashima O, Tanaka M, Okuda K, Nakashima M and Kojiro M: Portal vein invasion and intrahepatic micrometastasis in small hepatocellular carcinoma by gross type. Hepatol Res. 26:142–147. 2003. View Article : Google Scholar : PubMed/NCBI
22	Okusaka T, Okada S, Ueno H, Ikeda M, Shimada K, Yamamoto J, Kosuge T, Yamasaki S, Fukushima N and Sakamoto M: Satellite lesions in patients with small hepatocellular carcinoma with reference to clinicopathologic features. Cancer. 95:1931–1937. 2002. View Article : Google Scholar : PubMed/NCBI
23	Kokudo T, Hasegawa K, Matsuyama Y, Takayama T, Izumi N, Kadoya M, Kudo M, Ku Y, Sakamoto M, Nakashima O, et al: Survival benefit of liver resection for hepatocellular carcinoma associated with portal vein invasion. J Hepatol. 65:938–943. 2016. View Article : Google Scholar : PubMed/NCBI
24	Ishihara S, Haga H, Yasuda M, Mizutani T, Kawabata K, Shirato H and Nishioka T: Integrin beta1-dependent invasive migration of irradiation-tolerant human lung adenocarcinoma cells in 3D collagen matrix. Biochem Biophys Res Commun. 396:651–655. 2010. View Article : Google Scholar : PubMed/NCBI
25	Tsutsumi K, Tsuda M, Yazawa N, Nakamura H, Ishihara S, Haga H, Yasuda M, Yamazaki R, Shirato H, Kawaguchi H, et al: Increased motility and invasiveness of tumor cells that survived 10 Gy irradiation. Cell Struct Funct. 34:89–96. 2009. View Article : Google Scholar : PubMed/NCBI
26	Nishioka T, Yasuda M, Tsutsumi K, Haga H and Shirato H: Matrixmetalloproteinases: Up-regulated in subclones that survived 10-Gy irradiation. Radiat Med. 25:430–431. 2007. View Article : Google Scholar : PubMed/NCBI
27	Hokuto D, Nomi T and Yamato I: Colorectal liver metastasis resected in a salvage operation for local recurrence after proton beam radiotherapy. Jpn J Gastroenterol Surg. 48:684–690. 2015. View Article : Google Scholar
28	Bruix J and Sherman M: American Association for the Study of Liver Diseases: Management of hepatocellular carcinoma: An update. Hepatology. 53:1020–1022. 2011. View Article : Google Scholar : PubMed/NCBI
29	Chen F, Matsuo Y, Yoshizawa A, Sato T, Sakai H, Bando T, Okubo K, Shibuya K and Date H: Salvage lung resection for non-small cell lung cancer after stereotactic body radiotherapy in initially operable patients. J Thorac Oncol. 5:1999–2002. 2010. View Article : Google Scholar : PubMed/NCBI