Palliative radiation therapy for pulmonary metastases from hepatocellular carcinoma

Although the lung is the most common site of extrahepatic metastases from hepatocellular carcinoma (HCC), the optimal treatment for such metastases has'nt been established. External beam radiotherapy (EBRT) is becoming a useful local control therapy for lung cancer. To evaluated the efficacy of EBRT treatment for such metastases, we retrospectively studied 13 patients (11 men and 2 women; mean age, 52.6 years) with symptomatic pulmonary metastases from HCC who had been treated with EBRT in our institution. The palliative radiation dose delivered to the lung lesions ranged from 47 to 60 Gy (median 50) in conventional fractions, while the intrahepatic lesions were treated with surgery or transarterial chemoembolization, and/or EBRT. Follow-up period from radiotherapy ranged from 3.7 to 49.1 months (median, 16.7). Among the 13 patients, 23 out of a total of 31 pulmonary metastatic lesions received EBRT. In 12/13(92.3%) patients, significant symptoms were completely or partially relieved. An objective response was observed in 10/13(76.9%) of the subjects by computed tomography imaging. The median progression-free survival for all patients was 13.4 months. The 2-year survival rate from pulmonary metastasis was 70.7%. Adverse effects were mild and consisted of bone marrow suppression in three patients and pleural effusion in one patient (all CTCAE Grade II). In conclusion, EBRT with ≤60 Gy appears to be a good palliative therapy with reasonable safety for patients with pulmonary metastases from HCC. However, large-scale randomized clinical trials will be necessary to confirm the therapeutic role of this method.