A Novel Two-Stage Treatment combining Surgical Spacer Placement and Proton Beam Radiotherapy for Unresectable Colonic Liver Metastases: Report of a Case

Shohei Komatsu, Takumi Fukumoto, Yuichi Hori, Masao Murakami*, Yoshio Hishikawa* and Yonson Ku

Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine
Department of Radiology, Hyogo Ion Beam Medical Center*

We report a case of inoperable extra and intrahepatic metastasis from colon cancer successfully treated with spacer placement surgery and subsequent proton beam radiotherapy. A 74-year-old man undergoing sigmoidectomy and extended left hepatectomy for sigmoid colon cancer with synchronous multiple liver metastases, experienced recurrent hepatic metastasis 14 months later, together with a tumor thrombus extending into the inferior vena cava (IVC) and peritoneal seeding. FOLFOX was ineffective and abandoned with pulmonary fibrosis. The man was referred for particle radiotherapy. Because the liver tumor adjacent to the stomach precluded direct particle radiotherapy, we recommended two-stage treatment with spacer placement and subsequent proton beam radiotherapy. Our rationale was to displace the digestive tract from the irradiation field by spacer placement, thereby enabling proton beam radiotherapy. In the first stage, he underwent laparotomy to place Goretex sheets and the greater omentum to maintain distance between the tumor and stomach. A month later, in the second stage, he underwent proton beam radiotherapy of 64 GyE in 8 fractions. After two-stage treatment was completed, the two metastatic lesions had disappeared together with the IVC tumor thrombus.

Key words
metastatic liver cancer, inferior vena cava tumor thrombus, proton beam radiotherapy

Reprint requests
Shohei Komatsu Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University School of Medicine
7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 JAPAN

Accepted
April 22, 2009

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