J Korean Surg Soc.  2010 Dec;79(Suppl 1):S45-S49. 10.4174/jkss.2010.79.Suppl1.S45.

Hepatic Resection for Large Hepatic Metastasis of Adrenocortical Carcinoma after Cyberknife Treatment

• Kwon SW
• Choi IS
• Lee SE
• Choi WJ
• Yoon DS
• Min HS

• KMID: 2040552
• DOI: http://doi.org/10.4174/jkss.2010.79.Suppl1.S45

Abstract

Surgical resection is the best treatment for operable metastatic liver cancer. Large metastatic cancer usually has low operability, so a debulking modality of mass is needed to increase operability. Chemotherapy and radiotherapy were commonly used as neoadjuvant treatments. Cyberknife stereotactic radiosurgery systems were only considered as one of the palliative treatment modalities for inoperable or surgically complex tumors. But, in this case, we applied Cyberknife as the preoperative debulking modality for large hepatic metastasis of adrenocortical carcinoma. After Cyberknife treatment 3 cyclex2,700 cGY, tumor size decreased (metastatic liver mass decreased to 15x9 cm from 19x12.5 cm, adrenal mass decreased to 5x3 cm from 7.4x4.5 cm). We could then resect the tumor completely by extended right hemihepatectomy & right adrenalectomy. A preoperative multidisciplinary approach, including chemotherapy and radiation therapy can be considered to increase operability. So, cyberknife can be considered an additional modality as a neoadjuvant radiotherapy.

Keyword

Cyberknife; Neoadjuvant radiotherapy

MeSH Terms

Adrenalectomy
Adrenocortical Carcinoma
Liver
Liver Neoplasms
Neoadjuvant Therapy
Neoplasm Metastasis
Palliative Care
Radiosurgery

Figure

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  Fig. 1 Abdominal CT before cyberknife treatment. 19×12.5 cm sized huge mass was located in entire Rt. lobe and 7.4×4.5 cm sized mass was located in Rt. adrenal gland.

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  Fig. 2 Abdominal CT after cyberknife. CT scan shows decreased hepatic and Rt. adrenal mass. Hepatic mass was decreased to 15×9 cm; adrenal mass was decreased to 5×3 cm.

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  Fig. 3 Empty cavity post Extended Rt. lobectomy of liver and Rt. adrenalectomy replaced by small bowel, 2 weeks after operation.

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  Fig. 4 Cyberknife targets tumor in many directions. It focuses energy on tumor selectively and minimizes normal tissue damage.

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  Fig. 5 (A) Operative finding shows huge hypervascular mass below Rt. lobe of liver. (B) Shows remnant Lt. lobe and huge empty cavity after Extended Rt. lobectomy of liver.

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