Stereotactic body radiotherapy for solitary spine metastasis
In 2006, a 58-year-old man was diagnosed with hepatocellular carcinoma, cT1N0M0, stage I in segment 8 and was treated with transcatheter arterial chemoembolization and radiofrequency ablation, which controlled the liver lesion. Two years later, he visited hospital because of upper back and right shoulder pain. This was investigated by performing PET-CT and CT, which revealed a T3 spinal metastasis (). The patient was referred to our hospital for radiosurgery. At admission, he complained of sensory changes in both legs and in the lower abdominal area, and weakness in both lower extremities with fourth/fifth muscle strength. His VAS score for pain was 7, even with opioid analgesics. At that time, his ECOG performance status was 2, and the level of serum α-fetoprotein was elevated at 702 ng/mm3.\nA spine MRI before radiosurgery revealed a marrow infiltrative lesion at the pedicle, articular processes, laminas, and spinous process of T3, findings compatible with bone metastasis. Seven days after radiosurgery, the patient reported that his pain had started to improve. Subsequently, he reported that he was free of pain and no longer needed analgesics. Two weeks after radiosurgery, his neurologic symptoms resolved and his serum α-fetoprotein level dropped to 36.31 ng/mm3, and after 4 months, this level normalized at 2.99 ng/mm3. Since the radiosurgery was performed on the T3 spine, no further treatment was given until April 2012. At 52 months after radiosurgery, two liver lesions (8 and 12 mm) were found on segments 3 and 6, respectively, and treated with radiofrequency ablation. These two lesions were verified as controlled on follow-up liver CT and PET-CT and evidenced by a serum α-fetoprotein level of 2.4 ng/mm3. The metastatic T3 lesion had been radiologically controlled for 71 months after radiosurgery without relapse, pain, or neurological symptoms; in fact, there had been no evidence of disease.