Defining the role of palliative radiotherapy in bone metastasis from primary liver cancer: an analysis of survival and treatment efficacy
Defining the role of palliative radiotherapy in bone metastasis from primary liver cancer: an analysis of survival and treatment efficacy
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DOI：
10.1700/989.10720
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发表时间：
2011-09-01
期刊：
影响因子：
1.9
通讯作者：
Combs, Stephanie E.
中科院分区：
文献类型：
--
作者：
Habermehl, Daniel;Haase, Kristina;Combs, Stephanie E.
目的和背景。原发性肝癌是全球癌症相关死亡的第四大原因，而且预后仍然很差。众所周知，肝细胞癌和胆管细胞癌会导致骨转移，导致疼痛、神经功能障碍和骨折的风险。姑息性放射治疗是症状性骨病变的首选治疗方法，通常采用经皮分割放射治疗。1987年6月至2009年12月，我科共收治41例骨转移瘤患者，年龄中位数为。被分析的患者接受了67个部位的骨病变治疗。我们分析了应用的分割程序以及转移和症状的首选部位，从症状改善的角度评估了治疗结果，并描述了这些患者的预后。姑息性放射治疗的主要适应症是疼痛，占94%。最常见的放射治疗方案是10×3Gy20例和20x2Gy19例。中位总剂量39Gy4~48Gy.中位单次剂量2.5Gy1.8~4Gy.中位放射治疗时间15天(2-24天)，12例停止治疗。骨转移患者姑息性放射治疗总有效率为77%。胆管细胞癌和肝细胞癌患者放疗开始后的中位总生存期为4.2个月(范围0.2-38.9)。考虑到肝细胞癌和胆管癌骨转移患者的预后较差，根据我们的研究和现有文献，中位生存期为3.7-5.0个月，可以考虑较短的放射治疗方案，甚至是单次照射。
Aims and background. 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 and study design. 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.