A Case of Unresectable Hepatocellular Carcinoma Treated with Spacer Placement Surgery with Bioabsorbable Spacer and Subsequent Proton Beam Therapy.

Introduction: Hepatocellular carcinoma (HCC) often requires repeated therapy and poses challenges in treatment selection, particularly in patients with impaired liver function. Although hepatic resection, radiofrequency ablation, and liver transplantation are standard local curative therapies, the position of radiotherapy, including proton beam therapy (PBT), remains relatively underexplored. Herein, we report an illustrative case of unresectable HCC treated with spacer placement surgery using a bioabsorbable spacer, followed by PBT.

Case presentation: We report the case of a 77-year-old male patient diagnosed with a 6 cm HCC in segment 8, accompanied by impaired liver function, precluding hepatic resection. PBT was planned; however, because of the proximity of the gastrointestinal tract to the tumor, spacer placement was deemed necessary, and a bioabsorbable polyglycolic acid spacer was placed, followed by PBT. Owing to the sufficient space provided by the spacer, curative doses of PBT could be delivered to the tumor, and the patient survived for 26 months after spacer placement surgery without any sign of recurrence.

Conclusions: Bioabsorbable spacer placement surgery and subsequent PBT are feasible and promising treatment options for unresectable HCC with impaired liver function.