Clinical result of stereotactic radiosurgery for spinal metastasis from hepatocellular carcinoma: comparison with conventional radiation therapy

Abstract

We investigated the clinical outcome following stereotactic radiosurgery (SRS) for spinal metastasis from hepatocellular carcinoma (HCC) and compared it with that of conventional radiation therapy (cRT). Thirty-nine metastatic spine tumors from 27 HCC patients were treated with SRS from 2002 to 2011. Their medical records and radiological data were retrospectively analyzed. Median tumor volume was 49.7 cc, and a mean marginal dose of 28.7 Gy was delivered to the tumor mass. We analyzed overall survival (OS), local progression-free survival, and the rate of pain control following SRS. Factors relating to clinical outcomes were also investigated. Clinical results following cRT were obtained from 32 patients. The cRT protocol consisted of 30 Gy in 10 fractions or 39 Gy in 13 fractions. OS and local progression-free survival were compared between SRS and cRT. OS was a median of 7 months following SRS. Significant prognostic factors relating to OS included Child-Pugh class and Karnofsky performance scale. Tumor recurrence was noted in nine lesions during follow-up. The median local progression-free survival was 7 months. Previous irradiation was a significant prognostic factor for local recurrence (P = 0.043). The overall pain control rate was 85 % and no factors were found to be significantly correlated with the pain control rate. The median OS was 3 months in the cRT group and 7 months in the SRS group (P = 0.035). The median local progression-free survival was 2.0 months in the cRT group, and 7.0 months in the SRS group, which were significantly different (P = 0.033). SRS showed better local control than cRT in the treatment of HCC spinal metastasis.

Best of International Stereotactic Radiosurgery Society Congress 2013: Stereotactic Body Radiation Therapy. Part I: Spinal Tumors

“…Twenty seven patients with 39 spinal metastases were treated with CyberKnife ® (Accuray, CA, USA) SBRT to a single equivalent dose of 20 Gy (range: 12-28.5 Gy). The local recurrence rate was 23.1% [15]. Pain control was achieved in 84.6% of the lesions and 21.2% had recurrent pain.…”

“…Pain control was achieved in 84.6% of the lesions and 21.2% had recurrent pain. The median OS and progression-free survival (PFS) rates were 8 (19 for age ≤52 years and 7 for >52 years) and 7 months, respectively [15]. Patients who had prior radiotherapy had poorer PFS.…”

Establishment of a Disease-Specific Graded Prognostic Assessment for Hepatocellular Carcinoma Patients with Spinal Metastasis

“…The other clinical prognostic factors were not reported due to low or insufficient statistical strength, because most of the recruited studies were case series. Other studies reported age, Child-Pugh class, Karnofsky performance status scale, and Tomita score (Table 5) as significant factors affecting survival 14,16,28. However, reports of these prognostic factors were heterogeneous, and the number of studies and number of patients included in each study were relatively small.…”

“…Surgery can provide restoration of mechanical instability and emergent decompression,9,10 while chemotherapy can be used to treat systemically with targeted agent such as sorafenib 11–14. Radiotherapy (RT) can effectively provide palliation of painful SM in approximately 60% to 97% of patients, with up to 32% of patients experiencing a complete response in terms of pain relief 4,15,16. Although spinal involvement is thought to indicate a poor prognosis,5,16 patients with SM exhibit widely variable survival durations, and certain patients have favorable lifespans of up to 2 years 3,4,15.…”

“…Radiotherapy (RT) can effectively provide palliation of painful SM in approximately 60% to 97% of patients, with up to 32% of patients experiencing a complete response in terms of pain relief 4,15,16. Although spinal involvement is thought to indicate a poor prognosis,5,16 patients with SM exhibit widely variable survival durations, and certain patients have favorable lifespans of up to 2 years 3,4,15. In our previous report, the follow-up times of patients ranged from 0.5 to 125 months, and 32 of 192 patients (16.7%) survived for longer than 1 year 4.…”