A Novel Two-Stage Treatment combining Surgical Spacer Placement and Proton Beam Radiotherapy for Unresectable Colonic Liver Metastases: Report of a Case

症例は74歳の男性で，S状結腸癌の同時性多発肝転移に対してS状結腸切除術および拡大肝左葉切除術を施行した．14か月後，下大静脈腫瘍栓を伴う肝転移および腹膜播種を認めた．化学療法を開始するも効果なく，肺線維症を併発したため化学療法の継続を断念した．腹膜播種および肝転移に対する粒子線治療を希望し来院した．腫瘍は胃と近接しており粒子線による直接治療は不可能であったためスペーサー留置術＋粒子線照射による2段階治療を勧めた．まず，開腹下にスペーサーを留置し腫瘍と近接消化管の間に最低1.0 cmの距離を確保した．術後CT画像において安全な照射が可能であったため，手術1か月後より陽子線治療64 GyE/8 Frを施行した．治療後12か月時点で照射部腫瘍の再発は認めず，下大静脈腫瘍栓は消失した．本法は従来治療不能と考えられていた転移性肝癌に対して新たな治療手段になると考え報告した．

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