Improved oncologic outcomes by ablative radiotherapy in patients with bone metastasis from hepatocellular carcinoma.

Abstract

PURPOSE:

For bone metastasis from hepatocellular carcinoma (HCC), radiotherapy (RT) has been used a palliative treatment with little impact on survival. Currently, ablative RT is popularly used, and a more than palliative effect is expected. Herein, we investigated the clinical efficacy of ablative RT in patients with bone metastasis from HCC.

METHODS:

In total, 530 patients with 887 lesions treated in 1992-2019 were reviewed. Oligometastasis was defined as the presence of < 5 lesions. Total doses were normalized to obtain biologically effective doses (BEDs). The cut-off threshold of the BED was determined via receiver operating characteristics curve analysis. The Kaplan-Meier method was used to calculate overall survival (OS); propensity score matching (PSM) was performed to balance the heterogeneity in cases while comparing BEDs of ≥ 60 and < 60 Gy.

RESULTS:

The most common site of metastasis was the spine (59%); 59 patients (11%) presented with oligometastasis, and 76.2% of patients showed objective pain palliation after RT. Median OS was 5.1 months for all patients; patients with oligometastasis showed longer OS than those without (9.8 vs. 4.7 months). A Cox proportional hazards model showed that performance status, Child-Pugh class, extraosseous metastasis, primary HCC status, α-fetoprotein level, and radiation dose (BED) were significant prognostic factors. Post PSM, BED was the only treatment-related prognostic factor that remained significant; the median OS durations were 8.1 and 4.4 months when the BEDs were ≥ 60 and < 60 Gy, respectively.

CONCLUSION:

Ablative RT improved OS and pain palliation in patients with bone metastasis from HCC.

• Authors: Tae Hyung Kim, Sangjoon Park, Chai Hong Rim, Chiwhan Choi, Jinsil Seong
• Journal: Journal of cancer research and clinical oncology (J Cancer Res Clin Oncol) Vol. 147 Issue 9 Pg. 2693-2700 (Sep 2021) ISSN: 1432-1335 [Electronic] Germany
• PMID: 33582874 (Publication Type: Journal Article)
• Copyright: © 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature.

Topics

• Adult
• Aged
• Aged, 80 and over
• Bone Neoplasms (radiotherapy, secondary)
• Carcinoma, Hepatocellular (pathology, radiotherapy)
• Female
• Follow-Up Studies
• Humans
• Liver Neoplasms (pathology, radiotherapy)
• Male
• Middle Aged
• Prognosis
• Radiofrequency Ablation (mortality)
• Radiotherapy Dosage
• Retrospective Studies
• Survival Rate
• Young Adult