title: Radiosurgery Compared with External Radiation Therapy as a Primary Treatment in Spine Metastasis from Hepatocellular Carcinoma : A Multicenter, Matched-Pair Study.
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.
  
  
  CONCLUSIONS
  Clinical and radiological outcome were not significantly different between the two treatments. Toxicities, however, were more prevalent in the RT group.
authors.affiliation: Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.; Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea.; Clinical Research Institute, Seoul National University Hospital, Seoul, Korea.
authors.forename: Seil
authors.initials: S
authors.lastname: Sohn
authors.affiliation: Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.; Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea.; Clinical Research Institute, Seoul National University Hospital, Seoul, Korea.; Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Korea.
authors.forename: Chun Kee
authors.initials: CK
authors.lastname: Chung
authors.affiliation: Department of Neurosurgery, Ilsan Paik Hospital, College of Medicine, Inje University, Goyang, Korea.
authors.forename: Moon Jun
authors.initials: MJ
authors.lastname: Sohn
authors.affiliation: Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea.
authors.forename: Sung Hwan
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Nursing, College of Medicine, Chosun University, Gwangju, Korea.
authors.forename: Jinhee
authors.initials: J
authors.lastname: Kim
authors.affiliation: National Evidence-based Healthcare Collaborating Agency, Seoul, Korea.
authors.forename: Eunjung
authors.initials: E
authors.lastname: Park
keywords: Hepatocellular carcinoma; Metastasis; Radiation therapy; Radiosurgery; Spine