Palliative external-beam radiotherapy for bone metastases from hepatocellular carcinoma

Table 1 Incidence of bone metastases in clinical studies n (%)

Ref.	Study period	Patients	Extrahepatic Ms	Incidence of BMs	Rate of BMs in extrahepatic Ms
Kuhlman et al[13]	1979-1985	300		22 (7.3)
Liaw et al[14]	1983-1887	395		20 (5)
Katyal et al[15]	1992-1997	403	148 (36.7)	41(10.2)	28
Fukutomi et al[3]	1978-1987	269		12 (4.5)
	1988-1997	404		52 (12.9)
Natsuizaka et al[5]	1995-2001	482	65 (13.5)	25 (5.2)	38.50
Uchino et al[2]	1990-2006	2386	342 (14.3)	87 (3.6)	25.40
Senthilnathan et al[16]	2000-2008	209	51 (18)	5 (2)	10

BMs: Bone metastases; Ms: Metastases.

Table 2 Studies of external radiotherapy to treat painful bone metastases from hepatocellular carcinoma

Ref.	Patients (n)	Sites (n)	Fraction dose	Pain relief (CR)	Dose-response relationship	Comments
Roca et al[27]	26	37	MFs 30-50 Gy	79% (44%)	NR	11 lesions (with CTx)
Kaizu et al[28]	57	99	MFs 20-65 Gy	83.8% (33%)	Better pain relief	16 lesions (with TAE)
					TDF ≥ 77	Tumor volume (NS)
Matsuura et al[29]	38	44	MFs 26-60 Gy	91% (32%)	NR	Tumor regression
						(> 40 Gy)
Seong et al[7]	51	77	MFs 12.5-50 Gy	73%	Better pain relief	With neurological
					BED > 43 Gy	symptoms (25%)
He et al[8]	205	205	MFs 32-66 Gy	99.5% (29.80%)	NR	Higher retreatment rate
						(with soft-tissue masses)
Hayashi et al[30]	28	48	MFs 20-52 Gy	83% (17%)	NR	Longer pain relief
			SF 8 Gy	MFs: 87% (17%)		(> 36 Gy)
				SF: 75% (17%)		No spinal compression
						No neuropathic pain

MFs: Multiple fractions; SF: Single fraction; CR: Complete relief; NR: No dose response; TDF: Time, dose, and fractionation factor; BED: Biologically effective dose; NS: No significant difference; CTx: Chemotherapy; TAE: Transcatheter arterial embolization.