Palliative external-beam radiotherapy for bone metastases from hepatocellular carcinoma

Abstract

The incidence of bone metastases (BMs) from hepatocellular carcinoma (HCC) is relatively low compared to those of other cancers, but it has increased recently, especially in Asian countries. Typically, BMs from HCC appear radiologically as osteolytic, destructive, and expansive components with large, bulky soft-tissue masses. These soft-tissue masses are unique to bone metastases from HCC and often replace the normal bone matrix and exhibit expansive growth. They often compress the peripheral nerves, spinal cord, or cranial nerves, causing not only bone pain but also neuropathic pain and neurological symptoms. In patients with spinal BMs, the consequent metastatic spinal cord compression (MSCC) causes paralysis. Skull base metastases (SBMs) with cranial nerve involvement can cause neurological symptoms. Therefore, patients with bony lesions often suffer from pain or neurological symptoms that have a severe, adverse effect on the quality of life. External-beam radiotherapy (EBRT) can effectively relieve bone pain and neurological symptoms caused by BMs. However, EBRT is not yet widely used for the palliative management of BMs from HCC because of the limited number of relevant studies. Furthermore, the optimal dosing schedule remains unclear, despite clinical evidence to support single-fraction radiation schedules for primary cancers. In this review, we outline data describing palliative EBRT for BMs from HCC in the context of (1) bone pain; (2) MSCC; and (3) SBMs.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Hepatocellular carcinoma; Metastasis; Radiotherapy; Palliative therapy; Spinal cord compression; Skull base metastasis Core tip: Due to a lack of clinical data, external-beam radiotherapy (EBRT) for bone metastases (BMs) from hepatocellular carcinoma (HCC) is still not widely used as a palliative therapy component, and the optimal dosing schedule remains unclear. BMs from HCC typically occur as expansive, bulky soft-tissue masses; they exhibit expansive growth that compresses the peripheral nerves, spinal cord, or cranial nerves, causing both bone and neuropathic pain, and neurological symptoms. In this review, we outline the data describing palliative EBRT for BMs from HCC to treat bone pain, spinal compression, and skull base metastases.Hayashi S, Tanaka H, Hoshi H. Palliative external-beam radiotherapy for bone metastases from hepatocellular carcinoma.

WITHDRAWN: A randomized trial of conventional fraction versus hypofraction radiotherapy for bone metastases from hepatocellular carcinoma

“…These soft-tissue masses are unique to HCC BMs and often cause both bone and neuropathic pain. In patients with neuropathic pain, higher RT doses are necessary because of the presence of soft-tissue masses [19]. Our previous study suggested the retreatment rate was higher in patients with expansile soft tissue [5].…”

A Case of Solitary Metastasis from a Hepatocellular Carcinoma to the Sacral Bone Successfully Treated with Percutaneous Cryoablation

“…Both radiotherapy and chemotherapy with sorafenib are standard treatments for bone metastases from HCCs [1,6]. These treatments had previously been applied in the current case, and had been effective for 2 years.…”

“…, Hideo Gobara 1) , Takao Hiraki 1) , Toshihiro Iguchi 1) , Hiroyasu Fujiwara 1) , Jun Sakurai 2) , Yusuke Matsui 1) , Yoshihisa Masaoka 1) , Hiroki Ihara 3) , Toshiaki Wada 1) , Tomonori Seno…”

“…Bone metastases typically occur in multiple locations; therefore, these are usually treated palliatively, by radiotherapy and chemotherapy with sorafenib [1,6]. However, recent studies have shown that more aggressive local treatments are effective in select patients who have either solitary or few bone metastases [2][3][4][5].…”

“…The bones are one of the most common extrahepatic sites of metastases from hepatocellular carcinomas (HCC) [1][2][3][4][5]. Bone metastases typically occur in multiple locations; therefore, these are usually treated palliatively, by radiotherapy and chemotherapy with sorafenib [1,6].…”