Is there evidence for dose escalation of large bony metastases secondary to hepatocellular carcinoma?

Interesting question. The thing with HCC bone mets is that if you use only a nuclear bone scan to contour GTV you miss tumor, according to a paper from Korea (1), because HHC bone mets tend to have large soft tissue components.

Further, a Japan report(2) from 1998, looked at successful pain relief of bone mets using the TDF factors, and they found that if the TDF(time dose & fractionation) factor was greater than 77 patient had better response - pain relief.

DOSE Schemes: 300cGy x13 or 48Gy in 2.0 Gy fractions = >77 TDF.

Anything less than 77 was associated with poorer relief. Of course today, we used BED data for dose targeting.

So the take home message is:

1. Use MRI or CT scan imaging wihen planning

2. It seems DOSE ESCALATION MAY BE WARRANTED based on the local extent via CT/MRI imaging, or when associated soft tissue expansion that is seen in a significant number of these cases.

1.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2739323/

2. https://doi.org/10.1016/S0002-9270(98)00495-X