Research Papers:

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

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

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Oncotarget. 2017; 8:72860-72871. https://doi.org/10.18632/oncotarget.20529

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Gyu Sang Yoo1,*, Hee Chul Park1,5,*, Jeong Il Yu1, Do Hoon Lim1, Won Kyung Cho1, Eonju Lee6, Sang Hoon Jung1, Youngyih Han1, Eun-Sang Kim2, Sun-Ho Lee2, Whan Eoh2, Se-Jun Park3, Sung-Soo Chung3, Chong-Suh Lee3 and Joon Hyuk Lee4

1Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

2Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

3Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

4Department of Medicine (Division of Hepatology), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

5Department of Medical Device Management and Research, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea

6Department of Radiation Oncology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon-si, Korea

*These authors have contributed equally to this work as the first authors

Correspondence to:

Jeong Il Yu, email: [email protected]

Se-Jun Park, email: [email protected]

Keywords: stereotactic ablative body radiotherapy, spine, hepatocellular carcinoma, vertebral compression fracture

Received: March 15, 2017     Accepted: July 30, 2017     Published: August 24, 2017


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.

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