Abstract
External beam radiotherapy (EBRT) has been reported to be effective in palliating painful bone metastases, but the optimal fractions and doses for treating bone metastases from hepatocelluar carcinoma (HCC) are not established. This study aimed to compare toxicity and efficacy for conventional fraction versus hypofraction schedules. From January 2009 through December 2014, 183 patients with HCC bone metastases were randomly assigned to conventional fraction EBRT (Group A) or hypofraction radiotherapy (Group B). Study outcomes were pain relief, response rate and duration, overall survival, and toxicity incidence. Median follow-up time was 9.3 months. Response times were 6.7 ± 3.3 fractions in Group A and 4.1 ± 1.2 fractions in Group B (p <0.001). Pain relief rates were 96.7% and 91.2% in Group A and B, respectively (p=0.116). Time to treatment failure for Group A was significantly longer than Group B (p=0.025). Median overall survival was similar between two groups (p=0.628). Toxicity incidence in both groups was minimal, with no significant differences observed. In conclusion, hypofractionated radiotherapy is safe for patients with HCC bone metastases and may achieve earlier pain relief compared to conventional radiotherapy. This protocol should be considered for patients with shorter predicted survival times.
Highlights
An estimated 782,500 new primary liver cancer cases and 745,500 deaths occurred worldwide in 2012, with China alone accounting for about 50% of the total number of cases and deaths [1]
Hypofractionated radiotherapy is safe for patients with hepatocelluar carcinoma (HCC) bone metastases and may achieve earlier pain relief compared to conventional radiotherapy
Radiotherapy is an effective, time-efficient, welltolerated, and cost-effective intervention that is crucial for palliative oncology care [9], yet the optimal fractionated dose scheme for patients with HCC bone metastases (BMs) remains unclear
Summary
An estimated 782,500 new primary liver cancer cases and 745,500 deaths occurred worldwide in 2012, with China alone accounting for about 50% of the total number of cases and deaths [1]. The Radiation Therapy Oncology Group (RTOG) has previously studied various treatment fractionation regimens for palliation of bone metastases [6, 7], and shorter treatments were found to be as effective as longer treatments for achieving pain relief. Most of patients in these trials were suffering from prostate or breast cancer, and patients treated with a single-dose regimen of 8 Gray (Gy) were reported to have high rates of retreatment. These findings have been confirmed by other studies and meta-analysis [8,9,10]
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