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Clinical features and prognostic factors in patients with bone metastases from hepatocellular carcinoma receiving external beam radiotherapy
Version of Record online: 20 APR 2009
Copyright © 2009 American Cancer Society
Volume 115, Issue 12, pages 2710–2720, 15 June 2009
How to Cite
He, J., Zeng, Z.-C., Tang, Z.-Y., Fan, J., Zhou, J., Zeng, M.-S., Wang, J.-H., Sun, J., Chen, B., Yang, P. and Pan, B.-S. (2009), Clinical features and prognostic factors in patients with bone metastases from hepatocellular carcinoma receiving external beam radiotherapy. Cancer, 115: 2710–2720. doi: 10.1002/cncr.24300
- Issue online: 4 JUN 2009
- Version of Record online: 20 APR 2009
- Manuscript Accepted: 5 DEC 2008
- Manuscript Revised: 29 SEP 2008
- Manuscript Received: 15 MAY 2008
- hepatocellular carcinoma;
- external beam radiotherapy;
- bone metastases
The current study was performed to identify clinical features and independent predictors of survival in patients with bone metastases from hepatocellular carcinoma (HCC).
Patients (n = 205) with bone metastases from HCC received external beam radiotherapy (EBRT) between 1997 and 2007. Demographic variables, laboratory values, tumor characteristics, and treatment modalities were determined before EBRT. The total radiation dose ranged from 32 to 66 grays (Gy) (median, 50 Gy) and was focused on the involved bone.
In 80 of 205 (39.0%) patients with bone metastasis from HCC, tumors were characterized by osteolytic, expansile soft-tissue masses. Overall pain relief from EBRT occurred in 204 patients (99.5%). No consistent dose-response relation was found for palliation of bone metastases with doses between 32 and 66 Gy (P = .068), but the retreatment rate was higher in patients with expansile soft tissue. On univariate analysis, shorter survival was associated with poorer Karnofsky performance status (KPS), higher γ-glutamyltransferase and α-fetoprotein levels, tumor size >5 cm, uncontrolled intrahepatic tumors, multifocal bone lesions, involvement of spinal vertebrae, extraosseous metastases, and a shorter disease-free interval after an initial diagnosis of HCC. On multivariate analysis, pretreatment-unfavorable predictors were associated with lower KPS, higher tumor markers, and uncontrolled intrahepatic tumor when KPS was considered. The median survival was 7.4 months.
The results of the current study provide detailed information regarding clinical features, survival outcomes, and prognostic factors for HCC with bone metastases in a relatively large cohort of patients treated with EBRT. These prognostic factors will help in determining which dose and fraction are appropriate. Cancer 2009. © 2009 American Cancer Society.