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World J Hepatol. Dec 27, 2014; 6(12): 923-929
Published online Dec 27, 2014. doi: 10.4254/wjh.v6.i12.923
Palliative external-beam radiotherapy for bone metastases from hepatocellular carcinoma
Shinya Hayashi, Hidekazu Tanaka, Hiroaki Hoshi
Shinya Hayashi, Hidekazu Tanaka, Hiroaki Hoshi, Department of Radiology, Gifu University Hospital, Gifu 501-1194, Japan
Author contributions: Hayashi S collected the data, drafted the figures and wrote the manuscript; Tanaka H contributed to the writing of the manuscript; Hoshi H approved the final version to be published.
Correspondence to: Shinya Hayashi, MD, Assistant Professor, Department of Radiology, Gifu University Hospital, Yanagido 1-1, Gifu 501-1194, Japan. shayashi@gifu-u.ac.jp
Telephone: +81-58-2306439 Fax: +81-58-2306440
Received: July 26, 2014
Revised: August 31, 2014
Accepted: October 14, 2014
Published online: December 27, 2014
Processing time: 140 Days and 7.7 Hours
Abstract

The incidence of bone metastases (BMs) from hepatocellular carcinoma (HCC) is relatively low compared to those of other cancers, but it has increased recently, especially in Asian countries. Typically, BMs from HCC appear radiologically as osteolytic, destructive, and expansive components with large, bulky soft-tissue masses. These soft-tissue masses are unique to bone metastases from HCC and often replace the normal bone matrix and exhibit expansive growth. They often compress the peripheral nerves, spinal cord, or cranial nerves, causing not only bone pain but also neuropathic pain and neurological symptoms. In patients with spinal BMs, the consequent metastatic spinal cord compression (MSCC) causes paralysis. Skull base metastases (SBMs) with cranial nerve involvement can cause neurological symptoms. Therefore, patients with bony lesions often suffer from pain or neurological symptoms that have a severe, adverse effect on the quality of life. External-beam radiotherapy (EBRT) can effectively relieve bone pain and neurological symptoms caused by BMs. However, EBRT is not yet widely used for the palliative management of BMs from HCC because of the limited number of relevant studies. Furthermore, the optimal dosing schedule remains unclear, despite clinical evidence to support single-fraction radiation schedules for primary cancers. In this review, we outline data describing palliative EBRT for BMs from HCC in the context of (1) bone pain; (2) MSCC; and (3) SBMs.

Keywords: Hepatocellular carcinoma; Metastasis; Radiotherapy; Palliative therapy; Spinal cord compression; Skull base metastasis

Core tip: Due to a lack of clinical data, external-beam radiotherapy (EBRT) for bone metastases (BMs) from hepatocellular carcinoma (HCC) is still not widely used as a palliative therapy component, and the optimal dosing schedule remains unclear. BMs from HCC typically occur as expansive, bulky soft-tissue masses; they exhibit expansive growth that compresses the peripheral nerves, spinal cord, or cranial nerves, causing both bone and neuropathic pain, and neurological symptoms. In this review, we outline the data describing palliative EBRT for BMs from HCC to treat bone pain, spinal compression, and skull base metastases.