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

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.

Current role of proton beam therapy in patients with hepatocellular carcinoma

“…One of the toxicities after PBT requiring concern is chest wall toxicity. 64,65 As the prescribed dose is escalated in the treatment of HCC by PBT, the irradiation dose delivered to the chest wall is also frequently increased, especially when the HCC proximal to the chest wall is treated by PBT. 18 Toxicities in the chest wall present as chest wall pain due to radiation-induced myositis or rib fractures.…”

“…The radiation-induced myositis can be detected on T2weighted magnetic resonance imaging scan showing high signal intensity at the site of myositis which is included in the previous irradiated area. 64,66 The example of radiologic finding for the PBTinduced myositis at chest wall is shown in Fig. 4.…”