title: Defining the role of palliative radiotherapy in bone metastasis from primary liver cancer: an analysis of survival and treatment efficacy.
abstract: OBJECTIVE
  Primary liver cancer is the fourth leading cause of cancer-related death worldwide and is still associated with a poor prognosis. Hepatocellular carcinoma and cholangiocarcinoma are known to cause bone metastasis resulting in pain, neurologic impairment and risk of fracture. Palliative radiotherapy is the treatment of choice in symptomatic bone lesions and is usually performed as percutaneous fractionated radiotherapy.
  
  
  METHODS
  From June 1987 to December 2009, 41 patients (median age, 64 years) with bone metastasis received radiotherapy in our department. The analyzed patients were treated for 67 sites of bone lesions. We analyzed the applied fractionation schedules and the preferred sites of metastasis and symptoms, evaluated the therapeutic outcome in terms of symptomatic improvement, and described the prognosis of these patients.
  
  
  RESULTS
  Main indication for palliative radiotherapy was pain in 94% of all cases. Most frequent radiation protocols were 10 x 3 Gy (20 patients) and 20 x 2 Gy (19 patients). Median applied overall dose was 39 Gy (range, 4-48 Gy) and median single dose was 2.5 Gy (range, 1.8-4 Gy). The median duration of the radiotherapeutic treatment was 15 days (range, 2-24 days) and in 12 cases treatment was discontinuated. The overall response rate to palliative radiotherapy in bone metastasis was 77%. Median overall survival in both cholangiocarcinoma and hepatocellular carcinoma patients was 4.2 months after initiation of radiotherapy (range, 0.2-38.9).
  
  
  CONCLUSIONS
  Considering the poor prognosis of patients with bone metastasis in hepatocellular carcinoma and cholangiocarcinoma, with a poor median survival of 3.7-5.0 months according to our study and existing literature, shorter radiotherapy schedules or even single-fraction irradiation can be considered.
authors.affiliation: Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld, Heidelberg, Germany. daniel.habermehl@med.uni-heidelberg.de
authors.forename: Daniel
authors.initials: D
authors.lastname: Habermehl
authors.forename: Kristina
authors.initials: K
authors.lastname: Haase
authors.forename: Stefan
authors.initials: S
authors.lastname: Rieken
authors.forename: Jürgen
authors.initials: J
authors.lastname: Debus
authors.forename: Stephanie E
authors.initials: SE
authors.lastname: Combs
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000473:pathology; D001859:Bone Neoplasms / Q000532:radiotherapy* / Q000556:secondary*; D006528:Carcinoma, Hepatocellular / Q000532:radiotherapy; D018281:Cholangiocarcinoma / Q000532:radiotherapy; D019583:Dose Fractionation, Radiation; D005260:Female; D006500:Hepatic Duct, Common; D006801:Humans; D053208:Kaplan-Meier Estimate; D018285:Klatskin Tumor / Q000532:radiotherapy; D008113:Liver Neoplasms / Q000473:pathology*; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome