CLINICAL OUTCOMES AND ORTHOPEDIC SURGERY FOR BONE METASTASES FROM HEPATOCELLULAR CARCINOMA

Abstract

Purpose: The aim of the present study was to elucidate the clinical outcomes of hepatocellular carcinoma (HCC) metastases to bone. Methods: The clinical records of 15 patients diagnosed with HCC metastases to bone were retrospectively reviewed. The patients' mean age was 70.8 years. Patients were followed for an average period of 333 days. Clinical features, treatments and outcomes were analyzed. Results: Extrahepatic metastases, except to bone, were detectable in the lymph nodes of three patients (20.0%), the lungs of two patients (13.3%) and the adrenal glands of two patients (13.3%). Radiation therapy was carried out at 31 sites in 13 patients and its efficacy was calculated to be 80.6%. Orthopedic surgery was undertaken at 15 sites in 10 patients. Unexpected mortality due to bleeding occurred suddenly in two patients soon after surgery. Conclusions: Radiation therapy may be the first-choice palliative treatment for bone metastases from HCC. If the condition allows for residual liver function and a coagulative pattern, surgery must be considered for the treatment of some severe pain symptoms, including those caused by pathological fractures of long bones and increased symptoms due to nerve compression caused by spinal metastases. Surgical planning, such as preoperative transarterial embolization or intraoperative cementing, may play an important role in reducing intraoperative bleeding, which can lead to liver failure and death.