J Liver Cancer.  2019 Sep;19(2):136-142. 10.17998/jlc.19.2.136.

Radiation-induced Myositis after Proton Beam Therapy to Huge Hepatocellular Carcinoma

• Kim J
• Yoo GS
• Sinn DH
• Park HC
• Koh KC

• KMID: 2463614
• DOI: http://doi.org/10.17998/jlc.19.2.136

Abstract

Proton beam therapy (PBT) is one of the advances in radiotherapy techniques, which enables dose escalation with lower probability of radiation-induced liver or gastrointestinal injuries. However, the chest wall proximal to the tumor can be affected by high dose irradiation. Here, we report on a 58-year-old male patient who presented with huge hepatocellular carcinoma, received treatment with transarterial chemoembolization and PBT, and developed severe chest wall pain due to radiation-induced myositis. The patient's symptoms were controlled by oral steroids.

Keyword

Proton beam therapy; Myositis; Hepatocellular carcinoma; Sorafenib; Radiation recall phenomenon

MeSH Terms

Carcinoma, Hepatocellular*
Humans
Liver
Male
Middle Aged
Myositis*
Proton Therapy*
Protons*
Radiotherapy
Steroids
Thoracic Wall
Protons
Steroids

Figure

• 

  Figure 1. Initial magnetic resonance images showing huge hepatocellular carcinoma (HCC) with multiple nodular HCCs in the right lobe (arrows). A-P, arterial phase; D-P, delayed phase.

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  Figure 2. Isodose lines of proton beam therapy. The isodose lines show 30% to 100% of prescribed dose, 72.6 cobalt gray equivalents in 10 fractions.

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  Figure 3. Dose-volume histogram of proton beam therapy. The curve with dark brown color represents the dose volume histogram for chest wall. Maximum dose on chest wall is calculated as 71.1 cobalt gray equivalents (CGE), while dose for target volume reaches 72.6 CGE.

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  Figure 4. Serial computed tomography (CT) findings focusing on main hepatic mass and the chest wall (from left to right). (A) After the first transarterial chemoembolization (TACE), prior to the initiation of proton beam therapy (PBT). (B) A month after combination of TACE and PBT. The second TACE was performed afterwards. (C) Four months after completion of PBT. (D) CT scan taken 6 months after completion of PBT shows the swollen chest wall with low attenuation (inside the yellow ellipse).

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  Figure 5. Serial computed tomography (CT) scans showing improvement of radiation myositis (from left to right). (A) Six months after the proton beam therapy (PBT). (B) Eight months after PBT, CT revealed markedly decreased swelling of chest wall. (C) Nine months after PBT.

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