{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T19:23:54Z","timestamp":1792783434896,"version":"4.5.0"},"reference-count":10,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Tokyo Women's Medical University","id":[{"id":"https:\/\/ror.org\/03kjjhe36","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Clin J Gastroenterol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Although most hepatic hemangiomas require no treatment, giant lesions causing progressive symptoms, consumptive coagulopathy, or compression of adjacent organs may require intervention. Surgery remains the standard treatment but may not be feasible in patients with extensive bilobar disease or excessive operative risk. A 44-year-old woman presented with progressive abdominal fullness caused by multiple giant hepatic hemangiomas involving both hepatic lobes, the largest of which measured approximately 30\u00a0cm. Five years earlier, central bisectionectomy had been complicated by massive intraoperative bleeding, and the residual lesions subsequently enlarged. Because further surgery was considered high risk, staged three-dimensional conformal radiotherapy was performed to avoid simultaneous irradiation of the entire liver. The left-lobe lesion received 30\u00a0Gy in 15 fractions, followed approximately 2 years later by the same regimen for the enlarging right-lobe lesion. Both treatments resulted in marked tumor regression and symptomatic improvement. Fibrin degradation products and D-dimer levels decreased, fibrinogen levels normalized, and thrombocytopenia partially improved in association with the radiographic response. No grade 2 or higher treatment-related adverse events occurred. These findings suggest that staged bilateral radiotherapy may represent a feasible strategy for selected patients with symptomatic, unresectable giant hepatic hemangiomas and diffuse bilobar involvement for whom surgery is not feasible.<\/jats:p>","DOI":"10.1007\/s12328-026-02456-4","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T09:44:09Z","timestamp":1790243049000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Staged radiotherapy for symptomatic unresectable giant hepatic hemangiomas with diffuse bilobar involvement"],"prefix":"10.1007","author":[{"given":"Kenta","family":"Ohmatsu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sakura","family":"Nishiwaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirei","family":"Kamori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuka","family":"Kaizu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiho","family":"Wada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miki","family":"Tsujii","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sawa","family":"Kono","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunichi","family":"Ariizumi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuji","family":"Sakai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5599-4530","authenticated-orcid":false,"given":"Yaichiro","family":"Hashimoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"key":"2456_CR1","doi-asserted-by":"publisher","first-page":"386","DOI":"10.1016\/j.jhep.2016.04.001","volume":"65","author":"European Association for the Study of the Liver (EASL)","year":"2016","unstructured":"European Association for the Study of the Liver (EASL). EASL Clinical Practice Guidelines on the management of benign liver tumours. J Hepatol. 2016;65:386\u201398. https:\/\/doi.org\/10.1016\/j.jhep.2016.04.001.","journal-title":"J Hepatol"},{"key":"2456_CR2","doi-asserted-by":"publisher","first-page":"1614","DOI":"10.1016\/j.dld.2022.08.031","volume":"54","author":"M Pompili","year":"2022","unstructured":"Pompili M, Ardito F, Brunetti E, et al. Benign liver lesions 2022: Guideline for clinical practice of Associazione Italiana Studio del Fegato (AISF), Societ\u00e0 Italiana di Radiologia Medica e Interventistica (SIRM), Societ\u00e0 Italiana di Chirurgia (SIC), Societ\u00e0 Italiana di Ultrasonologia in Medicina e Biologia (SIUMB), Associazione Italiana di Chirurgia Epatobilio-Pancreatica (AICEP), Societ\u00e0 Italiana Trapianti d\u2019Organo (SITO), Societ\u00e0 Italiana di Anatomia Patologica e Citologia Diagnostica (SIAPEC-IAP) - Part II - Solid lesions. 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CT and MRI findings correlate with the time-course of unresectable cavernous haemangioma of the liver after fractionated radiotherapy. Br J Radiol. 2012;85:e49\u201352. https:\/\/doi.org\/10.1259\/bjr\/74795623.","journal-title":"Br J Radiol"},{"key":"2456_CR6","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1016\/j.ctro.2021.01.014","volume":"27","author":"S Shimizu","year":"2021","unstructured":"Shimizu S, Mizumoto M, Okumura T, et al. Proton beam therapy for a giant hepatic hemangioma: a case report and literature review. Clin Transl Radiat Oncol. 2021;27:152\u20136. https:\/\/doi.org\/10.1016\/j.ctro.2021.01.014.","journal-title":"Clin Transl Radiat Oncol"},{"key":"2456_CR7","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1016\/S0016-5085(19)32225-5","volume":"73","author":"N Okazaki","year":"1977","unstructured":"Okazaki N, Yoshino M, Yoshida T, et al. Radiotherapy of hemangioma cavernosum of the liver. 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The requirement for ethical approval was waived by the Institutional Review Board of Tokyo Women\u2019s Medical University as this was a single case report.","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Informed consent was obtained from the patient for the publication of this case report and the accompanying images.","order":3,"name":"Ethics","label":"Informed consent","group":{"name":"EthicsHeading","label":"Declarations"}}]}}