Abstract
We evaluated the pain and radiologic response, time to progression, and dose-response relationship after palliative radiotherapy for bone metastasis from hepatocellular carcinoma. We retrospectively reviewed the medical records of 91 patients between January 2004 and August 2012. The reviewed medical records included data on changes in pain, local tumor progression, and radiologic response evaluated via follow-up images. The radiologic response was assessed based on the Response Evaluation Criteria In Solid Tumors. The pain response was defined according to the International Bone Metastases Consensus Working Party palliative radiotherapy endpoints. Median radiation dose was 40 Gy (range, 20–66 Gy), with various fraction sizes (range, 2.0–6.0 Gy). Pain response rate was 81.4%. During the follow-up periods, radiologic local tumor progression was found in 42 patients (46.2%). The median time to progression was 14.1 months. When the patients were divided into two groups according to their radiation dose (< 55 Gy10 vs. ≥ 55 Gy10), the pain response rates of the high- and low-dose groups did not differ significantly (p = 0.728). However, the radiologic response rate and the time to progression showed significant differences between the two groups (p = 0.009 and p = 0.018, respectively). With dose escalation, higher radiologic response rates and a longer time to progression were achieved in patients with mass-forming bone metastases from hepatocellular carcinoma.
Highlights
Hepatocellular carcinoma (HCC) is the sixth most common cancer and the third leading cause of cancerrelated mortality worldwide [1, 2]
Bone metastases often cause a great deal of discomfort such as pain or associated neurologic symptoms
Many randomized controlled trials have been conducted to identify an adequate dose for palliation of bone metastasis [5,6,7, 9, 19]
Summary
Hepatocellular carcinoma (HCC) is the sixth most common cancer and the third leading cause of cancerrelated mortality worldwide [1, 2]. Extrahepatic metastasis is common and is being observed more frequently due to improved diagnostic methods and prolonged patient survival [3]. The most frequent extrahepatic metastasis site is the lung, followed by bone, lymph nodes, and adrenal gland. Bone metastasis in HCC occurs in 25–39% of patients with extrahepatic metastasis [3, 4]. In terms of pain relief, most previous studies failed to show a doseresponse relationship, but the sites of primary tumors from these studies were mainly prostate, breast, and lung cancers, not HCC [5, 7,8,9,10]
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