Proton Therapy: An Excellent Treatment Option for Giant Hepatic Hemangiomas
Most hepatic hemangiomas grow slowly and typically do not cause obvious clinical symptoms; they are usually detected during routine health check-ups or abdominal ultrasound and CT scans performed for other conditions.
In some patients, the hemangioma is large enough to compress adjacent organs—such as the gastrointestinal tract—leading to symptoms like upper abdominal discomfort, distension and pain, indigestion, nausea, and vomiting. In very rare instances, the hemangioma may rupture, triggering critical abdominal complications such as intraperitoneal hemorrhage.
Upon detection, the preferred clinical approach is regular follow-up to monitor changes in the tumor’s size and morphology, with timely intervention initiated should any abnormalities arise.
Treatment becomes necessary when the hemangioma exceeds 5 cm in diameter or causes clinical symptoms; when it continues to enlarge, compressing surrounding organs or adversely affecting the cardiovascular system; or when there is a risk of rupture, hemorrhage, or life-threatening complications. Current mainstream treatment modalities include surgical resection, interventional therapy, and radiotherapy.
46-Year-Old Woman Diagnosed with Giant Hepatic Hemangioma; Blood Transfusion Contraindication Complicates Surgery
Literature reports a case involving the use of proton therapy for a giant hepatic hemangioma. Researchers note that proton therapy is safe for treating hepatic hemangiomas, achieves ideal local control, causes no severe liver damage, and minimizes the risk of long-term adverse effects.
The patient was a 46-year-old woman with normal liver function. Elevated hepatobiliary enzyme levels were noted during a routine check-up, and an abdominal ultrasound revealed a hepatic mass. An abdominal CT scan showed an 80 × 80 mm lesion in the left lobe of the liver; combined with contrast-enhanced imaging, the lesion was confirmed to be a giant hepatic hemangioma.
Imaging also revealed peripheral bile duct dilation, with the bile ducts and blood vessels compressed by the tumor. Physical examination showed a flat, soft abdomen with tenderness in the right costal region. Comprehensive assessment indicated that the giant hepatic hemangioma required prompt intervention.
Continued Tumor Shrinkage and Sustained Remission for 15 Years After Proton Therapy
Due to religious restrictions preventing blood transfusions—which made surgical resection difficult to perform—the patient was referred for proton therapy. Initial assessment indicated Child-Pugh Class A liver function (suggesting good function or only mild impairment) and no elevation in tumor markers.
The patient underwent proton therapy with a total dose of 28.6 Gy delivered in 13 fractions. Following treatment, the tumor continued to shrink: it measured 50×50 mm after one year, 44×33 mm at 1.5 years, 40×26 mm at two years, and 36×26 mm at three years. Annual ultrasound follow-ups showed continued tumor regression.
An MRI scan 11 years post-treatment revealed the lesion had shrunk to 29×15 mm; the lesion appeared stable and was difficult to identify via ultrasound. Aside from localized atrophy in the irradiated area, the remaining liver structure remained intact, with no hepatic deformity. Follow-up blood tests showed no elevation in hepatobiliary enzymes, and symptoms of abdominal discomfort had completely resolved. The patient achieved a performance status score of 0, maintained a normal lifestyle, and attained clinical recovery. Ultrasound and imaging follow-ups confirmed that the state of remission has been sustained for 15 years.