title: Clinical features and prognostic factors in patients with bone metastases from hepatocellular carcinoma receiving external beam radiotherapy.
abstract: BACKGROUND
  The current study was performed to identify clinical features and independent predictors of survival in patients with bone metastases from hepatocellular carcinoma (HCC).
  
  
  METHODS
  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.
  
  
  RESULTS
  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 gamma-glutamyltransferase and alpha-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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Jian
authors.initials: J
authors.lastname: He
authors.forename: Zhao-Chong
authors.initials: ZC
authors.lastname: Zeng
authors.forename: Zhao-You
authors.initials: ZY
authors.lastname: Tang
authors.forename: Jia
authors.initials: J
authors.lastname: Fan
authors.forename: Jian
authors.initials: J
authors.lastname: Zhou
authors.forename: Meng-Su
authors.initials: MS
authors.lastname: Zeng
authors.forename: Jian-Hua
authors.initials: JH
authors.lastname: Wang
authors.forename: Jing
authors.initials: J
authors.lastname: Sun
authors.forename: Bing
authors.initials: B
authors.lastname: Chen
authors.forename: Ping
authors.initials: P
authors.lastname: Yang
authors.forename: Bai-Sheng
authors.initials: BS
authors.lastname: Pan
mesh_terms: D014408:Biomarkers, Tumor / Q000032:analysis; D001859:Bone Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary*; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary*; D018450:Disease Progression; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D007680:Kidney Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000532:radiotherapy; D011379:Prognosis; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D014408:Biomarkers, Tumor