Proton Beam Therapy With Space-Making Surgery (Omental Plombage) for Oligorecurrent Liver Metastasis of Esophageal Adenocarcinoma

Yojiro Ishikawa; Koji Morita; Hisashi Yamaguchi; Takahiro Kato; Motohisa Suzuki; Ichiro Seto; Masanori Machida; Kanako Takayama; Takuya Tominaga; Yoshiaki Takagawa; Masanobu Nakajima; Yasushi Teranishi; Yasuhiro Kikuchi; Masao Murakami

doi:10.7759/cureus.31656

Proton Beam Therapy With Space-Making Surgery (Omental Plombage) for Oligorecurrent Liver Metastasis of Esophageal Adenocarcinoma

Cureus. 2022 Nov 18;14(11):e31656. doi: 10.7759/cureus.31656. eCollection 2022 Nov.

Authors

Yojiro Ishikawa^{1

2}, Koji Morita¹, Hisashi Yamaguchi^{1

3}, Takahiro Kato^{4

5}, Motohisa Suzuki¹, Ichiro Seto¹, Masanori Machida¹, Kanako Takayama¹, Takuya Tominaga¹, Yoshiaki Takagawa^{1

3}, Masanobu Nakajima⁶, Yasushi Teranishi⁷, Yasuhiro Kikuchi⁸, Masao Murakami¹

Affiliations

¹ Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, JPN.
² Department of Radiology, Tohoku Medical and Pharmaceutical University, Sendai, JPN.
³ Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, JPN.
⁴ Department of Radiation Physics and Technology, Southern Tohoku Proton Therapy Center, Koriyama, JPN.
⁵ Department of Medical Radiology Technology, School of Health Sciences, Fukushima Medical University, Fukushima, JPN.
⁶ First Department of Surgery, Dokkyo Medical University, Mibu, JPN.
⁷ Department of Surgery, Southern Tohoku General Hospital, Koriyama, JPN.
⁸ Department of Neurosurgery, Southern Tohoku Research Institute for Neuroscience, Southern Tohoku General Hospital, Koriyama, JPN.

Abstract

Proton beam therapy (PBT) with space-making surgery has been used recently; however, its effectiveness for recurrent esophageal cancer (EC) is unclear. We herein report an unusual case of successful PBT with space-making surgery (omental plombage) for recurrent liver metastasis after EC surgery. A 58-year-old Japanese man underwent proximal gastrectomy for esophagogastric (EG) junction cancer seven months before presentation to our hospital. Microscopic findings after the surgery showed that the tumor was adenocarcinoma of the EG junction (pT1N0M0, stage I). Seven months after the proximal gastrectomy, liver metastases in S6 and S8 were revealed by positron emission tomography-computed tomography. Initial PBT was performed for those two liver metastases, and complete response (CR) was obtained for both liver metastases. Recurrence of liver metastasis in S2 was found eight months after the first PBT, and CR was achieved by chemotherapy. However, new liver metastasis recurred in S2. Considering the effects of radiation exposure on the surrounding gastrointestinal organs, we performed space-making surgery to place the omentum around the liver metastasis. We were able to complete the second PBT for the liver metastasis with 72.6 Gy relative biological effectiveness in 22 fractions. After the second PBT, the patient survived for seven years without recurrence. PBT with space-making surgery (omental plombage) for recurrent liver metastasis after EC surgery is considered to be a therapeutic option.

Keywords: esophageal adenocarcinoma; liver metastasis; oligometastasis; proton beam radiotherapy; space-making surgery.

Publication types

Case Reports