RT Effective for Palliation of Bone Metastases From HCC

A retrospective analysis found that radiotherapy was effective for the palliation of painful spinal metastases in patients with hepatocellular carcinoma (HCC) and highlights factors that could predict prognosis in these patients.

Researchers from the department of radiation oncology at the Yonsei Cancer Center, Seoul, Korea, sought to examine radiotherapy’s palliative effect in HCC patients with spinal metastases, as well as identify factors that could predict survival.

The results of the study were published in the journal Gut and Liver.

“Previous studies have suggested that prognostic factors … could predict overall survival in patients with spinal metastases from various solid tumors who receive radiotherapy,” the authors wrote. “However, little is known about the predictive factors associated with pain response and survival in radiotherapy-treated patients with spinal metastases from HCC.”

Anywhere from 5% to 25% of patients with HCC develop bone metastases, according to the study authors.

The researchers examined data from 192 HCC patients treated with radiotherapy for spinal metastases at the Yonsei Cancer Center between 1992 and 2012. More than half of the patients (54.7%) had multiple sites of spinal metastasis. The lumbar vertebrae (48 patients) and the thoracic vertebrae (46 patients) were the most commonly involved sites.

Pain response was evaluated using the Brief Pain Inventory. Pain was evaluated before the start of radiotherapy, 2 weeks after starting treatment, then every 3 months for 1 year.

Of the 192 patients, 187 patients (97.4%) had an overall pain response-41 patients (21.4%) had a complete pain response and 151 patients (78.6%) had a partial pain response.

A univariate analysis found that factors associated with a complete pain response were advanced radiotherapy techniques (P = .002) and a higher biologically effective dose (BED; P < .001).

“Because higher BEDs were associated with higher complete pain response rates in our study, poor performance status due to severe bone pain might be improved after dose-escalated radiotherapy, and the improved performance status might be associated with prolonged overall survival,” the authors suggested.

Median survival time was 4.5 months among patients studied, with overall survival rates of 18.1% at 12 months and 6.3% at 24 months for patients diagnosed with spinal metastases. A higher BED, controlled primary HCC, no extrahepatic metastases, and a good ECOG performance status were associated with longer overall survival.

“Radiotherapy provides effective palliation for patients with painful spinal metastases from HCC. In particular, radiotherapy with a higher BED may improve pain control and overall survival in these patients. The results of this study provide information regarding pain control, survival outcomes, and predictive factors for the prognosis of HCC patients with spinal metastases treated with radiotherapy,” the authors concluded.