The role of radiotherapy in the treatment of hepatocellular carcinoma (HCC) has been limited to date, because the liver has a low tolerance to radiation. However, reconstructing tumors and surrounding organs via a three-dimensional conformal planning system can avoid excess radiotherapy exposure to the rest of the liver and adjacent organs. Recently, the concept of "adaptive radiotherapy," such as with helical tomotherapy, has been introduced for treating HCC. Helical tomotherapy obtains an image from the computed tomography component, which allows targeted regions to be visualized prior to, during, and immediately after each treatment and delivers intensity-modulated radiation therapy. We report two patients with advanced HCC who underwent tomotherapy treatment. One was a patient afflicted with advanced HCC and a portal vein tumor thrombus, which was treated with tomotherapy combined with transarterial chemolipiodolization. The other was a patient afflicted with multiple pulmonary metastases treated with tomotherapy followed by systemic chemotherapy.
Adult ; Carcinoma, Hepatocellular/radiography/*radiotherapy/secondary ; Chemotherapy, Adjuvant ; Dose Fractionation ; Female ; Humans ; Imaging, Three-Dimensional ; Liver Neoplasms/pathology/radiography/*radiotherapy ; Male ; Neoplasm Invasiveness ; Radiographic Image Interpretation, Computer-Assisted ; *Radiotherapy Planning, Computer-Assisted ; *Radiotherapy, Conformal ; *Tomography, Spiral Computed ; Treatment Outcome

Reports of metastatic hepatocellular carcinoma (HCC) without a primary liver tumor are rare. Here we present a case of isolated HCC that had metastasized to the pelvic bone without a primary focus. A 73-year-old man presented with severe back and right-leg pain. Radiological examinations, including computed tomography (CT) and magnetic resonance imaging (MRI), revealed a huge mass on the pelvic bone (13x10 cm). He underwent an incisional biopsy, and the results of the subsequent histological examination were consistent with metastatic hepatocellular carcinoma. The tumor cells were positive for cytokeratin (AE1/AE3), hepatocyte paraffin 1, and glypican-3, and negative for CD56, chromogranin A, and synaptophysin on immunohistochemical staining. Examination of the liver by CT, MRI, positron-emission tomography scan, and angiography produced no evidence of a primary tumor. Radiotherapy and transarterial chemoembolization were performed on the pelvic bone, followed by systemic chemotherapy. These combination treatments resulted in tumor regression with necrotic changes. However, multiple lung metastases developed 1 year after the treatment, and the patient was treated with additional systemic chemotherapy.
Aged ; Bone Neoplasms/*diagnosis/*pathology/radiotherapy ; Carcinoma, Hepatocellular/*pathology/radiography/*secondary ; Chemoembolization, Therapeutic ; Combined Modality Therapy ; Glypicans/metabolism ; Humans ; Keratin-1/metabolism ; Keratin-3/metabolism ; Liver Neoplasms/*pathology/radiography/*secondary ; Magnetic Resonance Imaging ; Male ; Paraffin/metabolism ; Pelvic Bones/*pathology/radiography ; Positron-Emission Tomography ; Tomography, X-Ray Computed