Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea.
J Cancer Res Clin Oncol. 2021 Sep;147(9):2693-2700. doi: 10.1007/s00432-021-03553-2. Epub 2021 Feb 13.
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.
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.
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.
Ablative RT improved OS and pain palliation in patients with bone metastasis from HCC.
对于肝细胞癌（HCC）的骨转移，放射治疗（RT）一直被用作姑息性治疗，对生存几乎没有影响。目前，消融性 RT 被广泛应用，预计会有超过姑息性的效果。在此，我们研究了消融性 RT 治疗 HCC 骨转移患者的临床疗效。
共回顾了 1992 年至 2019 年间接受治疗的 530 例 887 处病灶的患者。寡转移定义为存在 < 5 处病变。总剂量进行归一化以获得生物有效剂量（BED）。通过接收者操作特征曲线分析确定 BED 的截止阈值。Kaplan-Meier 法用于计算总生存期（OS）；采用倾向评分匹配（PSM）来平衡病例之间的异质性，同时比较 BEDs≥60 和 < 60 Gy 的情况。
最常见的转移部位是脊柱（59%）；59 例（11%）患者表现为寡转移，76.2%的患者在 RT 后出现客观疼痛缓解。所有患者的中位 OS 为 5.1 个月；寡转移患者的 OS 长于无寡转移患者（9.8 与 4.7 个月）。Cox 比例风险模型显示，表现状态、Child-Pugh 分级、骨外转移、原发性 HCC 状态、甲胎蛋白水平和辐射剂量（BED）是显著的预后因素。PSM 后，BED 是唯一具有显著意义的与治疗相关的预后因素；当 BEDs≥60 和 < 60 Gy 时，中位 OS 分别为 8.1 和 4.4 个月。
消融性 RT 可改善 HCC 骨转移患者的 OS 和疼痛缓解。
