Case Report
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World J Gastroenterol. Jul 14, 2014; 20(26): 8729-8735
Published online Jul 14, 2014. doi: 10.3748/wjg.v20.i26.8729
Two-stage treatment with hepatectomy and carbon-ion radiotherapy for multiple hepatic epithelioid hemangioendotheliomas
Shohei Komatsu, Takeshi Iwasaki, Yusuke Demizu, Kazuki Terashima, Osamu Fujii, Atsushi Takebe, Akihiro Toyokawa, Kazuhiro Teramura, Takumi Fukumoto, Yonson Ku, Nobukazu Fuwa
Shohei Komatsu, Atsushi Takebe, Takumi Fukumoto, Yonson Ku, Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Hyogo 650-0017, Japan
Takeshi Iwasaki, Department of Surgery, National Hospital Organization, Kobe Medical Center, Hyogo 654-0155, Japan
Yusuke Demizu, Kazuki Terashima, Osamu Fujii, Nobukazu Fuwa, Department of Radiology, Hyogo Ion Beam Medical Center, Hyogo 679-5165, Japan
Akihiro Toyokawa, Department of Surgery, Yodogawa Christian Hospital, Osaka 533-0024, Japan
Kazuhiro Teramura, Department of Pathology, Yodogawa Christian Hospital, Osaka 533-0024, Japan
Author contributions: Komatsu S wrote the manuscript and performed additional data analysis; Iwasaki T helped by supervising and approving the final manuscript; Demizu Y, Terashima K, Fujii O and Fuwa N performed particle radiotherapy; Takebe A, Toyokawa A were attending doctors of the patient; Teramura K made a pathological diagnosis; Fukumoto T and Ku Y developed a new treatment procedure and supervised the manuscript.
Correspondence to: Shohei Komatsu, MD, PhD, Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Hyogo 650-0017, Japan. komasho8@gmail.com
Telephone: +81-78-3826302 Fax: +81-78-3826307
Received: November 19, 2013
Revised: February 10, 2014
Accepted: March 7, 2014
Published online: July 14, 2014
Processing time: 237 Days and 10.8 Hours
Abstract

Hepatic epithelioid hemangioendothelioma (HEH) is a rare neoplasm of vascular origin with variable malignant potential. Because most patients with this condition have multiple bilobar lesions, liver transplantation is the standard treatment, and hepatectomy is much less frequently indicated. We describe a case of a 35-year-old woman with unresectable multiple bilobar HEH successfully treated by combination treatment with hepatectomy and carbon-ion radiotherapy. This case is very meaningful since it demonstrated the effectiveness of carbon-ion radiotherapy for HEH and the possibility of expanding the curative treatment options for multiple bilobar hepatic tumors.

Keywords: Two-stage treatment; Hepatic epithelioid hemangioendothelioma; Hepatectomy; Carbon-ion radiotherapy; Particle radiotherapy; Omental flap spacer

Core tip: Hepatic epithelioid hemangioendothelioma (HEH) is a rare neoplasm with variable malignant potential. Liver transplantation is the most frequently reported treatment because most patients have multifocal bilobar lesions. Here, we describe a case of a 35-year-old woman with unresectable multiple bilobar HEH that was successfully treated by combination treatment of hepatectomy and carbon-ion radiotherapy. This case demonstrated two significant points: the effectiveness of carbon-ion radiotherapy for HEH and the possibility of expanding the curative treatment options for multiple bilobar hepatic tumors.