Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 16, 2022; 10(8): 2591-2603
Published online Mar 16, 2022. doi: 10.12998/wjcc.v10.i8.2591
Hepatocellular carcinoma effective stereotactic body radiotherapy using Gold Anchor and the Synchrony system: Two case reports and review of literature
Sakue Masuda, Toshitaka Tsukiyama, Yumiko Minagawa, Kazuya Koizumi, Makoto Kako, Takeshi Kinbara, Uojima Haruki
Sakue Masuda, Kazuya Koizumi, Makoto Kako, Takeshi Kinbara, Uojima Haruki, Department of Gastroenterology, Shonankamakura General Hospital, Kanagawa 247-8533, Japan
Toshitaka Tsukiyama, Department of Interventional Radiology Center, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
Yumiko Minagawa, Department of Radiation Oncology, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
Author contributions: Masuda S, Koizumi K, Kako M, Kinbara T, and Uojima H were the patient’s hepatologists, reviewed the literature, and contributed to manuscript drafting; Masuda S and Minagawa Y reviewed the literature and contributed to manuscript drafting; Tsukiyama T and Minagawa Y were the radiologists and performed the radiotherapy and contributed to manuscript drafting; Tsukiyama T analyzed and interpreted the imaging findings; Masuda S, Uojima H, Tsukiyama T, and Minagawa Y were responsible for the revision of the manuscript and for important intellectual content; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patients for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sakue Masuda, MD, Chief Doctor, Department of Gastroenterology, Shonankamakura General Hospital, 1370-1 Okamoto Kamakura, Kanagawa 247-8533, Japan. sakue.masuda@tokushukai.jp
Received: September 15, 2021
Peer-review started: September 15, 2021
First decision: November 11, 2021
Revised: November 12, 2021
Accepted: January 29, 2022
Article in press: January 29, 2022
Published online: March 16, 2022
Processing time: 176 Days and 10.7 Hours
Abstract
BACKGROUND

Radiotherapy for hepatocellular carcinoma (HCC) is considered to have limited efficacy because of treatment intensity considering that the irradiated area includes the liver, which is highly radiosensitive. In this report, we present two cases in which tumor control by surgical resection, radiofrequency ablation, transcatheter arterial chemoembolization (TACE), and lenvatinib administration was difficult, but stereotactic body radiotherapy (SBRT) using the Synchrony system by Radixact™ and Gold Anchor® (GA) was effective.

CASE SUMMARY

A 60-year-old man had a single 10-cm HCC in the right lobe. Viable lesions remained after TACE, and levels of alpha-fetoprotein and protein induced by vitamin K antagonists II (PIVKA-II) decreased and quickly re-elevated. We performed SBRT with GA. Three weeks after implantation, localized radiotherapy (SBRT; 40 Gy/5 fractions) was performed using the Synchrony system by Radixact™. Four weeks later, the viable lesion had disappeared, and the PIVKA-II levels decreased. A 77-year-old man had a single 12-cm HCC in the right lobe. The patient experienced recurrence after hepatectomy. Further recurrence occurred after TACE, and we performed SBRT with GA. Because of the proximity of the HCC to the gastrointestinal tract, localized radiotherapy (SBRT; 39 Gy/13 fractions) to the HCC was performed 3 wk after implantation using the Synchrony system by Radixact™. Four weeks later, the viable lesion had disappeared on computed tomography, and the PIVKA-Ⅱ levels decreased.

CONCLUSION

SBRT using the Synchrony system and GA can deliver a large dose accurately and safely, and could have a high therapeutic effect.

Keywords: Fiducial marker; Hepatocellular carcinoma; Gold Anchor®; Radixact™; Stereotactic body radiotherapy; Case report

Core Tip: Radiotherapy using fiducial markers has been performed for hepatocellular carcinoma (HCC) for several years. However, the Gold Anchor® (GA) used in this report is a new fiducial marker with a small diameter, which is expected to reduce the incidence of complications. The Synchrony system by Radixact™ is also a new radiation device, which is useful in respiratory motion management and allows complete tracking of the HCC in which the GA is implanted. Radiotherapy using these devices was highly effective for HCC that could not be controlled by surgery, transcatheter arterial chemoembolization, or molecular targeted drugs.