Author information
1
Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York.
2
Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York; NYU Winthrop University Hospital, Mineola, NY.
3
Biostatistics Shared Resource Facility, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
4
Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
5
NYU Winthrop University Hospital, Mineola, NY.
6
Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York.
7
Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: Michael.buckstein@mountsinai.org.
Abstract
PURPOSE:
To evaluate the efficacy of stereotactic radiosurgery (SRS) for spinal metastases from hepatocellular carcinoma (HCC) compared with other radioresistant histologies (renal cell carcinoma (RCC), melanoma, and sarcoma) in terms of local control (LC) and pain control.
METHODS:
We performed a retrospective review of patients treated with SRS to the spine for metastatic HCC, RCC, melanoma, and sarcoma from January 2007 through May 2014. Radiographic assessment of LC, OS, and patient-reported pain control were analyzed as univariable analyses and with various patient- and treatment-related parameters as multivariable analyses (MVA).
RESULTS:
Of 96 patients treated with SRS, 41 patients had radioresistant histologies, including 18 HCC, 1 mixed HCC/cholangiocarcinoma, 15 RCC, 6 melanoma, and one leiomyosarcoma. Extraosseous disease was present in 63% (74% in HCC and 55% in non-HCC, NS). Spinal cord compression was present in 29% (32% in HCC and 27%, in non-HCC, NS), and 24% had decompressive surgery prior to SRS (26% in HCC and 23% in non-HCC, NS). With median follow up of 8.7 months, actuarial 3, 6, and 12-month LC rates were 71%, 61%, 41% for HCC, and 94%, 94%, and 85% for non-HCC. Median time to local failure was 3 months for HCC and 11 months for non-HCC. On MVA, there was a strong trend toward inferior LC with HCC (p=0.059). Of 28 patients with pre-treatment pain, pain relief was achieved in 93%, but the two patients who did not experience pain relief both had HCC. Actuarial 3, 6, and 12-month pain control rates were 68%, 51%, 17% for HCC, and 100%, 89%, 89% for non-HCC (p=0.023), and this remained significant on MVA (p=0.034).
CONCLUSIONS:
When compared to other radioresistant histologies, HCC has inferior local control and pain relief after SRS. Whether HCC may benefit from further dose escalation or combined treatment with new therapies is an area of future research.