Tae Hyung Kim1, Sangjoon Park1,2, Chai Hong Rim1,3, Chiwhan Choi1,4, Jinsil Seong5. 1. Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea. 2. Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea. 3. Department of Radiation Oncology, Ansan Hospital, Korea University Medical College, Ansan, Korea. 4. Department of Radiation Oncology, St. Carollo General Hospital, Suncheon, Korea. 5. Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea. JSSEONG@yuhs.ac.
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.
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: David A Palma; Robert Olson; Stephen Harrow; Stewart Gaede; Alexander V Louie; Cornelis Haasbeek; Liam Mulroy; Michael Lock; George B Rodrigues; Brian P Yaremko; Devin Schellenberg; Belal Ahmad; Sashendra Senthi; Anand Swaminath; Neil Kopek; Mitchell Liu; Karen Moore; Suzanne Currie; Roel Schlijper; Glenn S Bauman; Joanna Laba; X Melody Qu; Andrew Warner; Suresh Senan Journal: J Clin Oncol Date: 2020-06-02 Impact factor: 44.544