肝細胞癌是東亞常見的癌症之一，具有血管侵犯的特性，主要是侵犯肝門脈系統。然而，極少數的情況下，肝細胞癌也可能藉由侵犯肝靜脈而轉移至右心房，通常這類病人的預後都非常差。手術切除心房內腫瘤是這類病人的首選治療方式，但對這類病人的病況而言，通常這樣的治療卻又太過侵襲性。本文報告一名58歲的肝細胞癌病人，其腫瘤具有肝靜脈、不腔靜脈及右心房侵犯的現象，因不適於接受其他較具侵入性之治療，因此安排接受三度空間順形放射治療(共60 Gy ，分33次照射) ，及一個療程的肝動脈內化學治療( cisplatin 65 mg/m2連續滴注 6小時之後接著5-fluorouracil 2200 mg/m2連續滴注24小時)。血清中甲種胎兒蛋白指數顯著降低，同時伴隨著心房內腫瘤縮小。此病人自診斷起存活超過15個月。就此病例的觀察，吾人可以說，對於併有右心房轉移的肝細胞癌病人，三度空間順形放射治療加上化學治療或可以作為不適於手術的病人另一種替代療法。

Hepatocellular carcinoma (HCC) is a common malignant neoplasm in East Asia. HCC has the tendency to invade vessels, mainly the portal venous system. Right atrium metastasis through venous invasion is a rare condition with grave prognosis. Surgical resection of intra-atrial tumors is technically difficult and it is too invasive for the seriously ill patients. Here, we present a 58-year-old male patient of HCC with hepatic veins, inferior vena cava, and right atrium invasion, who received well-designed three-dimensional conformal radiotherapy (totally 60 Gy 33 fractions), followed by one course of intra-arterial chemotherapy with cisplatin (65 mg/m2 infusion for 6 hours) and 5-fluorouracil (2,200 mg/m2 infusion for 24 hours). Serum alpha-fetoprotein was markedly decreased, and size of tumor thrombus was shrinkage. This patient survived for 15 more months. Therefore, for HCC patients with right atrium metastasis, three-dimensional conformal radiotherapy plus chemotherapy may be an effective salvage treatment.