Angiographic Findings in Patients with Hepatocellular Carcinoma Previously Treated Using Proton Beam Therapy

Figure 1

A 70-year-old woman underwent her first and second proton beam therapy (PBT) treatment for hepatocellular carcinoma (HCC) in S7 43 months (1) and 16 months (not shown) before the angiography, respectively. Dynamic computed tomography before the transarterial chemoembolization revealed local recurrence of the PBT-treated HCC, with early enhancement at the hepatic arterial phase and washout at the equilibrium phase (arrow). The surrounding irradiated parenchyma exhibited delayed enhancement (arrowhead) (2,3). A tortuous tumor feeder was noted during the procedure (4), although enhancement of the recurrent HCC was obscured by the abnormal staining of the irradiated liver parenchyma (5). Cone-beam computed tomography clearly showed that the selected artery fed the recurrent tumor (white arrow) (6).