Radiotherapy for painful bone metastases from hepatocellular carcinoma

Background: Painful bone metastases are one of the distressing clinical situations in patients with hepatocellular carcinoma (HCC). The purpose of the study was to evaluate the palliative effect of radiotherapy for painful bone metastases from HCC. Patients and Methods: A retrospective analysis was performed upon 51 patients, who were treated with radiotherapy for painful bone metastases from HCC at 77 sites, from January 1991 to June 2000. Twenty patients (39%) presented synchronous metastases, and the remaining 31 patients (61%) showed metachronous metastases. In addition to bone pain, neurologic symptoms and a palpable mass were presented in 13 (25%) and seven (13%) patients, respectively. Twenty-one patients (41%) had a solitary metastasis and the most frequent site was the vertebra. The total dose of radiotherapy ranged from 12.5 to 50 Gy (median 30 Gy). Results: On the Wisconsin Brief Pain Questionnaire, relief of pain was achieved at 56 sites (73%). The overall survival rate at 2 years was 4% and the median survival time was 5 months. Univariate analysis showed that tumor stage within the liver and the presence of metastases to organs, other than bones, were significant prognostic factors for survival (P < 0.05). Conclusion: In conclusion, radiotherapy provides effective palliation for patients with painful bone metastases from HCC during the substantial median survival time.