Analysis Of Effect And Prognosis Of Radiotherapy For Primary Liver Cancer With Bone Metastasis

ObjectiveIn recent years,the incidence of bone metastasis of primary liver cancer?BMPLC?has gradually increased,and it has been widely concerned.This study summarized the epidemiological and clinical characteristics of the disease,evaluated the therapeutic effect of radiotherapy,and further analyzed the prognostic factors of the disease,in order to provide the reference for clinical diagnosis and treatment.MethodsThe age,gender,liver function,bone metastasis site,type,quantity,radiotherapy dose and segmentation mode,time interval from the diagnosis of primary liver cancer?PLC?to the detection of bone metastasis and other relevant information were collected in 68 BMPLC patients who had received radiotherapy for bone metastasis site from July,2013 to March,2019 in First Hospital of Jilin University.The clinical characteristics,radiotherapy effect and prognostic factors of these patients were analyzed retrospectively.ResultsThe most common sites of BMPLC is located at the axial bone,including the spine?60.77%?and ribs?15.39%?,followed by the pelvis?11.54%?and skull?6.15%?.Most of them showed osteolytic changes?78.46%?,while a considerable part of them were periosteal soft tissue metastases?49.23%?unique to BMPLC.Meanwhile,35 patients?51.47%?presented with multiple bone metastases.There was no significant difference in pain relief rate between the different biologically effective doses?BED?and the single irradiation dose subgroups(BED₁₀<55 Gy group vs BED₁₀?55 Gy group:75.55%vs 83.33%,P=0.535;single dose<3 Gy group vs single dose?3 Gy group:78.13%vs 80.85%,P=0.767).However,the median pain relief time?9 f,95%CI:6.99-11.01f?was longer in the group with a single dose<3 Gy than that in the group with a single dose?3Gy?6 f,95%CI:5.19-6.81 f?,and the difference was statistically significant?P=0.006?.The median bone metastasis-free survival time was 12 months?0-108 months?.Bone metastasis-free survival was significantly longer in patients treated with standardized intrahepatic primary tumors than in patients without systemic treatment?surgical vs ablation vs hepatic arterial chemoembolization vs other or untreated:12months vs 12 months vs 14 months vs 0 month,P=0.001?.The median survival time after bone metastasis for all patients was 10 months?1-32 months?.According to univariate analysis,the median survival time after bone metastasis was 13 months and9 months in the PS score 0-1 and 2-5 groups,respectively,while 11 months and 8months in the Child-Pugh grade A and B groups,respectively,with statistically significant differences?PS score:P=0.019;Child-Pugh grade:P=0.021?.Multivariate analysis showed that age?HR=1.997,95CI%:1.059-3.767,P=0.033?and Child-Pugh grade of liver function?HR=2.944,95%CI:1.221-7.100,P=0.016?were prognostic factors affecting survival time after bone metastasis.ConclusionBMPLC is a disease with an increasing incidence.Radiotherapy can effectively alleviate patients'symptoms and improve their QOL.The increased dose of single irradiation can make the pain relieved more quickly,but the optimal irradiation dose and fractionation mode need to be further explored.Age,performance status,and liver function are important prognostic factors.Active treatment of primary tumors and protection of liver function are still needed for long-term survival.