External beam radiation therapy in a centenarian with primary liver cancer: A case report

RATIONALE: Due to unprecedented global aging, the number of elderly and super-elderly patients with cancer is increasing. However, restricted by comorbidities or fragility, many elderly patients are considered ineligible to receive invasive therapies. A centenarian with primary liver cancer (PLC) was treated by external beam radiation therapy (EBRT). This rare case deserves our attention. PATIENT CONCERNS: We present a rare case of a centenarian with PLC. The super-elderly male patient complained that 2 liver lesions were found by abdominal ultrasonography in June 2016. DIAGNOSES: The Segment 7 (S7) lesion and the Segment 5/8 (S5/8) lesion were clinically diagnosed as PLC successively. INTERVENTIONS: The S7 lesion was considered PLC initially and treated by EBRT in October 2016. In the 1-year follow-up after EBRT, the S7 lesion was well controlled. Unfortunately, the S5/8 lesion had increased in size, was diagnosed as PLC and subsequently treated by CyberKnife in another hospital. However, local failure of the S5/8 lesion was suggested 15 months after CyberKnife. At the age of 102 years, the patient received re-irradiation for the S5/8 lesion. OUTCOMES: Three months after re-irradiation, des-γ-carboxy-prothrombin decreased to normal; no significant change in the S5/8 lesion was found in Magnetic Resonance Imaging. No severe acute or late toxicities were reported after each course of EBRT. Unfortunately, the patient died of respiratory failure caused by severe pneumonia in mid-March 2020. CONCLUSION: Advanced age is not a contraindication for elderly patients with cancer to receive radiotherapy and even re-irradiation.