Stereotactic ablative body radiotherapy for spinal metastasis from hepatocellular carcinoma: its oncologic outcomes and risk of vertebral compression fracture.

Gyu Sang Yoo,Se-Jun Park,Chong-Suh Lee,Jeong Il Yu,Eonju Lee,Sung-Soo Chung,Do Hoon Lim,Eun-Sang Kim,Joon Hyuk Lee,Sang Hoon Jung,Youngyih Han,Sun-Ho Lee,Whan Eoh,Hee Chul Park,Won Kyung Cho

doi:10.18632/oncotarget.20529

Abstract

Spinal metastases from hepatocellular carcinoma (HCC) require high-dose irradiation for durable pain and tumor control. Stereotactic ablative body radiotherapy (SABR) enables the delivery of high-dose radiation. However, but vertebral compression fracture (VCF) can be problematic. The aim of his study is to evaluate the outcome and risk of VCF after SABR for spinal metastasis from HCC. We retrospectively reviewed 33 lesions in 42 spinal segments from 29 patients who received SABR with 1 fraction (16-20 Gy), or 3 fractions (18-45 Gy) from September 2009 to January 2015. The 1-year local control (LC) rate was 68.3%. Radiographic grade of cord compression (RGCC) was the only independent prognostic factor associated with LC (P = 0.007). The 1-year ultimate LC rate including the outcome of salvage re-irradiation was 87.2%. The pain response rate was 73.3% according to the categories of the International Bone Metastases Consensus Group. The 1-year VCF-free rate was 71.5%. Pre-existing VCF (P < 0.001) and only-lytic change (P = 0.017) were associated with a higher post-SABR VCF rate. One-third of post-SABR VCFs required interventions. SABR for spinal metastases from HCC provided efficacious LC, especially for lesions with RGCC ≤ II, and showed effective and durable pain relief. As VCF after SABR occurred frequently for vertebral segments with pre-existing VCF and only-lytic change, early preventive vertebroplasty is considerable for those high-risk vertebral segments.

Highlights

Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and the second leading cause of cancer-related death [1]
We evaluated the oncologic outcome and the risk of post-Stereotactic ablative body radiotherapy (SABR) vertebral compression fracture (VCF) for spinal metastasis from hepatocellular carcinoma (HCC) which requires a high-dose irradiation, possibly by SABR, and at the same time, is vulnerable to post-SABR VCF
For lesions with Radiographic grade of cord compression (RGCC) ≤ II, 1-year local control (LC) rate was 92.9% which is comparable to previous results of other literatures reporting LC as 80-90% [10]

Summary

Introduction

Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and the second leading cause of cancer-related death [1]. Distant metastasis is less likely in HCC than other tumors, the incidences have increased in the last decade as the overall survival (OS) of patients with metastatic HCC has improved [2, 3]. Efficient palliation of metastasis from HCC has become an important clinical issue. Spinal metastasis is estimated to represent 40% of bone metastases from HCC [4]. Radiotherapy (RT) is the most commonly used modality for spinal metastasis from HCC. RT of 30 Gy in 10 fractions is widely accepted as conventional regimen for spinal metastasis. As dose-response relationships between RT dose and symptom palliation have been reported, and conventional RT for spinal metastasis from HCC showed a high retreatment rate of up to 50%, there have been efforts to deliver a higher dose to spinal metastases from HCC [4,5,6]

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