Patient, male, 66 years old, diagnosis: pancreatic cancer with liver metastasis.

‌Patient Profile‌: Male, 66 years old, Diagnosis: Pancreatic Cancer with Liver Metastasis.

‌Medical History‌: The patient was admitted to the hospital in February 2024 due to abdominal pain without apparent provocation. A local abdominal CT scan revealed: A mass in the tail of the pancreas with malignant features, encasing the left renal vein and appearing to invade the left renal artery, stomach, and left adrenal gland. Several slightly hypodense nodules in the liver, suggest metastatic tumors. For further treatment, the patient visited our hospital on April 18, 2024. After admission, relevant examinations were completed. A pancreatic tumor biopsy indicated moderately differentiated pancreatic ductal adenocarcinoma. Immunohistochemical results showed: C-erbB-2 (0), CK19 (+), CK20 (-), CK7 (+), Ki-67 (index ≈ 5%), P53 (wild type), S100p (-). Gene testing detected a KRAS G12D mutation. An abdominal MRI scan suggested a mass in the tail of the pancreas, with local encasement of the left renal vein and unclear boundaries with the left adrenal gland, gastric wall, and left renal arteries and veins, most likely representing pancreatic cancer; multiple liver metastases were also observed. After excluding contraindications, the patient underwent carbon ion radiotherapy for pancreatic cancer and liver metastasis starting on  May 1, 2024. The total dose for the pancreatic lesion was PTV 36Gy(RBE)/9Fx and PTVboost 22.5Gy(RBE)/5Fx; the dose for liver metastasis was PTV 40Gy(RBE)/10Fx and PTVboost 20Gy(RBE)/5Fx. Concurrently, the patient received chemotherapy with "gemcitabine + albumin-bound paclitaxel" on May 1 and May 8, 2024. A follow-up abdominal MRI scan after treatment indicated a decrease in the size of the lesion in the tail of the pancreas compared to the scan on May 13, 2024. Multiple liver metastases had also decreased in size for the most part.

‌Treatment Plan‌: Carbon ion radiotherapy for pancreatic cancer with a total dose of 56Gy(RBE)/14Fx.Carbon ion radiotherapy for liver metastasis with a total dose of 60Gy(RBE)/15Fx.Concurrent chemotherapy with albumin-bound paclitaxel + gemcitabine.

‌Treatment Effect‌: After treatment, a follow-up abdominal MRI scan showed a decrease in the size of the pancreatic lesion and most liver metastases compared to previous scans.

                          Before treatment                                                                                                After treatment

                  Before treatment                                                                                                       After treatment