With a Precise Plan, a Rare Liver Tumour, and a Completely Silent Victory

Surgery combined with adjuvant image-guided radiotherapy (Helical Tomotherapy) was used to treat a high-grade solitary fibrous tumour (SFT) of the liver.

Establishing the context (the reasons why this is important)

It is common for solitary fibrous tumours to originate from the pleura; however, they can manifest themselves virtually anywhere. Less than a few dozen cases have been reported all over the world, which indicates that they are extremely uncommon in the liver. The most effective method of control is complete surgical removal with clean margins. In cases of high-grade disease, post-operative radiotherapy (RT) can be helpful in maintaining the safety of the affected area. This is due to the fact that they can grow rapidly and sometimes behave in an aggressive manner.

As soon as he arrived

A 61-year-old male displayed a general sense of well-being; however, a routine ultrasound examination revealed the presence of a substantial mass in the left lobe of the liver, measuring approximately 11 centimetres by 10 centimetres. In the past, he had been diagnosed with hemangiopericytoma (2008), which is a tumour that falls on the same biological spectrum as SFT.
An unmistakable mass in the left lobe was confirmed by a triphasic CT scan. As a result of the high-grade malignant neoplasm that was discovered through USG-guided biopsy, the surgical team decided to proceed with a left hepatectomy. SFT of a high grade was the final pathology.

Clearly and uncomplicatedly, the plan

The hepato-pancreato-biliary surgeon, the medical oncologist, and the radiation oncologist all participated in a joint discussion regarding the case from that point on. Considering the high-grade histology and the fact that the surgery was curative, the team suggested adjuvant radiation therapy in order to lessen the likelihood of microscopic residual disease to take hold. Although there is no standard proven regimen for SFT, chemotherapy was not planned to be administered.

How we were able to deliver the radiation (with pinpoint accuracy)

Image-guided radiotherapy (IGRT) with Helical Tomotherapy (Radixact X9, Accuray Precision v3.3.1.3) is the technique that is being utilised.

The dose and the target:

Sixty Gy in thirty fractions for the tumour bed surrounding the surgical clips

Elective regions that are at risk should receive 54 Gy in 30 fractions simultaneously.

When it came to nearby organs that were at risk (such as the stomach, bowel, liver remnant, and so on), all plans adhered to dose limits. We were able to shape the dose so that it was close to the bed while sparing normal tissues thanks to the helical “wrap-around” beam.

Remarkably smooth tolerance is a quality. There were no symptoms of nausea, vomiting, abdominal pain, or loose stools. His body weight remained stable throughout the course of treatment. Currently, he is being closely monitored.

Logic behind why this worked (story logic)

Right first step: the most effective beginning was achieved by performing a complete resection of a large, high-grade tumour.

It is important to consider biology: high-grade features and size increase the risk of recurrence, and adjuvant radiotherapy adds local insurance.

Through the use of Helical Tomotherapy, modern IGRT planning was able to conform the dose to the bed and elective corridors while simultaneously protecting organs.

Discipline of the team: A multi-specialty plan that was systematically carried out ensured that the course ran smoothly.

In the grand scheme of things (what the literature might suggest)

SFTs are uncommon; liver SFTs are even less common, typically measuring between 8 and 10 centimetres when they are discovered, and up to twenty percent of them can exhibit malignant behaviour.

A comprehensive surgical resection that incorporates negative margins is the foundational component.

In high-grade, large, or close-margin cases, adjuvant radiation therapy (RT) is frequently considered. Data collected at the population level indicate that surgical combined with radiation therapy (RT) yields better results than surgery alone in certain patients.

RT alone can achieve meaningful control in a subset of patients with unresectable surface fibrosis; there is no standard chemotherapy available.

It is prudent to conduct a lengthy follow-up because recurrences can manifest themselves years later.

Ways in which we would explain it to the family

After removing the tumour in its entirety, we used high-precision radiation to secure the region where microscopic cells could have been hiding. The treatments did not cause any discomfort and were well tolerated. We will now keep a close eye on things and conduct follow-ups.

A snapshot of the clinician (ready for drop-ins)

Patient is a male, aged 61 years, with an incidental liver mass in the left lobe measuring approximately 11 centimetres by 10 centimetres.

Triphasic computed tomography reveals a clearly defined left-lobe mass

The biopsy revealed a high-grade malignant neoplasm, which led to the left hepatectomy.

High-grade solitary fibrous tumour (SFT) is referred to as HPR.

Adjuvant radiotherapy (no chemotherapy) was the decision made by the MDT.

Helical TomoTherapy (Radixact X9) is the application platform for RT; IGRT

(clips) 60 Gy/30# to bed; 54 Gy/30# elective (SIB) doses are recommended.

There was no gastrointestinal toxicity, and the patient’s weight was maintained. OARs: Constraints were respected.

At this time, we are under surveillance and doing well clinically.

Taking away

When it comes to ultra-rare liver SFT, the combination of complete resection and adjuvant, image-guided helical RT has the potential to provide quiet, long-lasting control with minimal toxicity. This presents a precise plan for a rare problem that is carried out effectively.