J Korean Neurosurg Soc.  2016 Jan;59(1):37-43. 10.3340/jkns.2016.59.1.37.

Radiosurgery Compared with External Radiation Therapy as a Primary Treatment in Spine Metastasis from Hepatocellular Carcinoma : A Multicenter, Matched-Pair Study

• Sohn S
• Chung CK
• Sohn MJ
• Kim SH
• Kim J
• Park E

• KMID: 2152916
• DOI: http://doi.org/10.3340/jkns.2016.59.1.37

Abstract

OBJECTIVE
The aim of this multicenter, matched-pair study was to compare the outcomes of stereotactic radiosurgery (SRS) and conventional external radiation therapy (RT) when used as a primary treatment in spine metastasis from hepatocellular carcinoma (HCC).
METHODS
From 2005 to 2012, 28 patients underwent SRS as the primary treatment in spine metastasis from HCC. Based on sex, age, number of spine metastasis, Child-Pugh classification, interval from original tumor to spine metastasis, and year of treatment, 28 patients who underwent RT were paired. Outcomes of interest were pain relief, progression free survival, toxicities, and further treatment.
RESULTS
The perioperative visual analog scale (VAS) decrease was larger in SRS group than in RT group, but the difference was not significant (3.7 vs. 2.8, p=0.13). When pain medication was adjusted, the number of patients with complete (n=6 vs.3) or partial (n=12 vs.13) relief was larger in SRS group than in RT group; however, the difference was not significant (p=0.83). There was no significant difference in progression free survival (p=0.48). In SRS group, 32.1% of patients had 1 or more toxicities whereas the percentage in RT group was 63.0%, a significant difference (p=0.04). Six SRS patients and 7 RT patients received further intervention at the treated segment.
CONCLUSION
Clinical and radiological outcome were not significantly different between the two treatments. Toxicities, however, were more prevalent in the RT group.

Keyword

Radiosurgery; Radiation therapy; Spine; Metastasis; Hepatocellular carcinoma

MeSH Terms

Carcinoma, Hepatocellular*
Classification
Disease-Free Survival
Humans
Neoplasm Metastasis*
Radiosurgery*
Spine*
Visual Analog Scale

Figure

• 

  Fig. 1 Representative cases of spine metastasis from hepatocellular carcinoma (HCC) in stereotactic radiosurgery (SRS) (upper column : A, B, and C) and external radiation therapy (RT) (lower column : D, E, and F) groups. Pretreatment axial T1-weighted gadolinium-enhanced MRI reveals spine metastasis at L4 (A). This patient underwent SRS with a prescribed dose of 40 Gy in 4 fractions. Axial projection represents the 80% isodose line of the treatment. Colored outlined areas represent 120% (red), 80% (yellow), 50% (green), and 30% (blue) isodose lines of the treatment (B). MRI taken 7 months later reveals no tumor growth (C). Pretreatment axial T1-weighted gadolinium-enhanced MRI reveals spine metastasis at L5 (D). This patient underwent RT with the prescribed dose of 30 Gy in 10 fractions (E). MRI taken 5 months later reveals no tumor growth (F). V : vertebral body, S : spinal cord, T : tumor.

• 

  Fig. 2 Kaplan-Meier estimates of overall survival did not differ between SRS and RT groups (p=0.85). Median overall survival after treatment was 8 months in the SRS group and 10 months in the RT group. SRS : stereotactic radiosurgery, RT : external radiation therapy.

• 

  Fig. 3 Kaplan-Meier estimates of progression free survival did not differ significantly between the SRS and RT groups (p=0.48). Median progression free survival after treatment was 10 months in the SRS group and 8 months in the RT group. SRS : stereotactic radiosurgery, RT : external radiation therapy.

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