• Clinical trials
• Combination therapy
• Hepatocellular carcinoma
• Immunotherapy
• Molecular targeted therapy

• Humans
• Carcinoma, Hepatocellular/therapy
• Carcinoma, Hepatocellular/drug therapy
• Liver Neoplasms/pathology
• Chemoembolization, Therapeutic
• Combined Modality Therapy

• No. 2020-2819 Indian Council of Medical Research
• No. BT/RLF/Re-entry/58/2017 Department of Biotechnology, Ministry of Science and Technology, India

• ablation therapy
• cryoablation
• extrahepatic metastases
• hepatocellular carcinoma
• microwave ablation
• percutaneous ethanol injection
• radiofrequency ablation

• Hepatocellular carcinoma
• bone metastasis
• external beam radiation therapy
• liver cancer
• metastasis
• radiotherapy

Skull base metastasis (SBM) from hepatocellular carcinoma (HCC) presents detrimental survival outcomes with cranial nerve symptoms; however, they have received little attention. This study aimed to investigate the clinical presentation and efficacy of radiation therapy (RT) in patients with SBM from HCC.

We identified patients with SBM from HCC in Yonsei Cancer Center from 2005 to 2019. Image evaluations and SBM-related symptoms were reviewed. Overall survival was calculated using the Kaplan–Meier method and compared through the Log rank test. The oligometastasis group included patients with less than five foci of tumors, while the extensive metastasis group presented five or more sites.

The incidence of SBM from HCC was 1.5% (58/3793 patients), commonly found in the middle cranial fossa. SBM associated symptoms presented in 51 patients, and the most common were head and neck area pain, and orbital symptoms, The palliation rate after RT was 65% (24/39 patients) for overall symptoms and 83.3% (20/24 patients) for cranial nerve symptoms. In whole cohort, overall survival was analyzed, and the median overall survival of patients with oligometastasis was better than extensive metastasis (23.7 months vs 1.8 months, p < 0.001). In subgroup who received RT (39 patients), the median overall survival was 23.7 and 2.7 months for patients with oligo and extensive metastasis, respectively (p < 0.001).

This study confirmed clinical features of SBM from HCC. Overall survival was generally poor, but patients presenting oligometastasis seemed to have possibility of relative long-term survival. Although radiation was effective in SBM-induced symptom relief, dose–response relationship in local control rate and overall survival needs further studies with larger number of patients.

• hepatocellular carcinoma
• oligometastasis
• radiotherapy
• skull base metastasis

Oral metastasis by hepatocellular carcinoma (OMHCC) is extremely rare, and the prognosis had been reported quite poor due to simultaneous multiple organ metastases. In this study, we report clinical features and survival of 10 new cases of OMHCC and suggest the criteria for palliative surgery.

A retrospective clinical study including 10 new cases of oral OMHCC between 2006 and 2016 was performed. Clinical features and survival analysis were examined. The recorded variables were age, sex, site of oral metastases, size of oral tumor (largest diameter), and survival after oral histopathologic diagnosis.

There was male (n=8) predilection of OMHCC. The mean survival time was 16.9 months. Patient age ranged from 40 to 71 years (mean 56.5). Eight mandibular and two maxillary lesions were found. One patient showed simultaneously the maxilla and the oral tongue involvement. The most often encountered symptoms were swelling (80%) followed by pain (60%), numbness (60%), bleeding (10%), and tooth mobility (10%). Four patients underwent operation due to spontaneous bleeding and swelling of the cancer. Overall (from onset of hepatocellular carcinoma) and truncated survival (from onset of OMHCC) were 71.9 and 13.1 months respectively.

The prognosis of OMHCC was quite poor. Oral and jaw bone examination should be included in patients with multiple metastasis of HCC. Palliative surgery might be performed in patients who reported spontaneous bleeding, severe pain, and oral dysphasia due to tumor enlargement.

• Cancer
• Hepatocellular carcinoma
• Metastatic cancer
• Oral metastasis
• Survival

It is still controversial whether hepatocellular carcinoma (HCC) patients with lymph node invasion should receive surgery treatment. This study aimed to evaluate the efficacy of surgery (liver resection and local tumor destruction treatments) in HCC patients with regional lymph node metastasis.

The study utilized data from the Surveillance, Epidemiology, and End Results-18 (SEER-18) cancer registry. Patients for whom the treatment type was not clear or those with distant metastasis or without regional lymph nodule invasion were excluded. For survival analysis, patients with the survival months coded as 0 and 999 were excluded. All 1434 patients were included in the analysis. Among them, 168 patients were treated surgically and the other 1266 received non-surgery therapy. Propensity score matching (PSM) model was used to reduce selection bias.

Before PSM, the median overall survival (mOS) and median cancer-specific survival (mCSS) of patients treated surgically were longer than that of receiving non-surgery treatment (mOS 20 months, 95% CI 15.3–24.7 vs. 7 months, 95% CI 6.4–7.6, P < 0.001; mCSS 21 months, 95% CI 115.5–26.5 vs. 6 months, 95% CI 5.3–6.7, P < 0.001). Subgroup analysis found no significant differences in mOS and mCSS between liver resection and non-liver resection surgery cohorts (P = 0.886 and P = 0.813, respectively). Similar results were obtained in the PSM analysis. The mOS and mCSS in the surgery group were longer than those in the non-surgery group (mOS 20 months vs. 7 months, P < 0.001; mCSS 20 months vs. 6 months, P < 0.001). The multivariate analysis documented that surgery was an independent predictor for OS and CSS before and after PSM.

HCC patients with invasion of regional lymph nodules may get more survival benefit from surgery than other types of treatment.

• Efficacy
• Hepatocellular carcinoma
• Liver resection
• Surgery

• Bone marrow
• Hepatocellular carcinoma
• Lymphopenia
• Neoplasm metastasis
• Radiotherapy

• Ablative therapy
• Chemoembolization
• Cholangiocarcinoma
• Hepatocellular carcinoma
• Palliation
• Targeted therapies

• Antineoplastic Agents/therapeutic use
• Biliary Tract Neoplasms/pathology
• Biliary Tract Neoplasms/therapy
• Catheter Ablation
• Chemoembolization, Therapeutic/methods
• Combined Modality Therapy
• Humans
• Liver Neoplasms/pathology
• Liver Neoplasms/therapy
• Palliative Care
• Prognosis

External beam radiotherapy (EBRT) has been reported to be effective in palliating painful bone metastases, but the optimal fractions and doses for treating bone metastases from hepatocelluar carcinoma (HCC) are not established. This study aimed to compare toxicity and efficacy for conventional fraction versus hypofraction schedules. From January 2009 through December 2014, 183 patients with HCC bone metastases were randomly assigned to conventional fraction EBRT (Group A) or hypofraction radiotherapy (Group B). Study outcomes were pain relief, response rate and duration, overall survival, and toxicity incidence. Median follow-up time was 9.3 months. Response times were 6.7 ± 3.3 fractions in Group A and 4.1 ± 1.2 fractions in Group B (p <0.001). Pain relief rates were 96.7% and 91.2% in Group A and B, respectively (p=0.116). Time to treatment failure for Group A was significantly longer than Group B (p=0.025). Median overall survival was similar between two groups (p=0.628). Toxicity incidence in both groups was minimal, with no significant differences observed.

In conclusion, hypofractionated radiotherapy is safe for patients with HCC bone metastases and may achieve earlier pain relief compared to conventional radiotherapy. This protocol should be considered for patients with shorter predicted survival times.

• conventional fractionation
• external beam radiotherapy
• hepatocellular carcinoma
• hypofractionated
• toxicity

• Carcinoma, hepatocellular
• Diagnosis
• Guidelines
• Management

• Aged
• Carcinoma, Hepatocellular/pathology
• Carcinoma, Hepatocellular/therapy
• Female
• Hepatitis B, Chronic/epidemiology
• Humans
• Liver Neoplasms/pathology
• Liver Neoplasms/therapy
• Male
• Middle Aged
• Prevalence
• Republic of Korea/epidemiology

• National Cancer Center

• Carcinoma
• Diagnosis
• Guidelines
• Management
• hepatocellular

• Carcinoma, Hepatocellular/virology
• Disease Management
• Gastroenterology/standards
• Hepacivirus
• Hepatitis B virus
• Hepatitis B, Chronic/complications
• Hepatitis C, Chronic/complications
• Humans
• Liver Neoplasms/virology
• Republic of Korea

• Liver cancer
• evidence
• radiation therapy
• survival

• Carcinoma, Hepatocellular/complications
• Carcinoma, Hepatocellular/radiotherapy
• Carcinoma, Hepatocellular/surgery
• Chemoembolization, Therapeutic
• Humans
• Liver Neoplasms/complications
• Liver Neoplasms/radiotherapy
• Liver Neoplasms/surgery
• Liver Transplantation
• Neoplasm Metastasis
• Radiotherapy/adverse effects
• Radiotherapy/methods
• Venous Thrombosis/etiology

• Bone metastases
• Carcinoma

Hepatocellular carcinoma (HCC) patients with spinal metastasis (SM) show heterogeneous lengths of survival. In this study, we develop and propose a graded prognostic assessment for HCC patients with SM (HCC-SM GPA).

We previously reported the outcomes of 192 HCC patients with SM who received radiotherapy from April 1992 to February 2012. Prognostic factors that significantly affected survival in that study were used to establish the HCC-SM GPA. Validation was performed using an independent cohort of 63 patients recruited from September 2011 to March 2016.

We developed the HCC-SM GPA using the following factors: Eastern Cooperative Oncology Group performance status (0–2, 0 point; 3–4, 1 point), controlled primary HCC (yes, 0 point; no, 2 points), and extrahepatic metastases other than bone (no, 0 point; yes, 1 point). Patients were stratified into low (GPA=0), intermediate (GPA=1 to 2), and high risk (GPA=3 to 4). When applied to the validation cohort, the HCC-SM GPA determined median survival durations of 13.6, 4.8, and 2.6 months and 1-year overall survival rates of 58.3%, 17.8%, and 7.3% for the low-, intermediate-, and high-risk patient groups, respectively (p<0.001).

Our newly proposed HCC-SM GPA successfully predicted survival outcomes.

• Carcinoma, hepatocellular
• Graded prognostic assessment
• Spinal metastasis
• Survival

• bone metastasis
• coracoid process
• hepatocellular carcinoma
• mandible

• Bone Neoplasms/secondary
• Carcinoma, Hepatocellular/secondary
• Coracoid Process/pathology
• Humans
• Liver Neoplasms/pathology
• Male
• Mandibular Neoplasms/secondary
• Middle Aged

• Diagnosis
• Hepatocellular carcinoma
• Staging
• Surveillance
• Treatment

• Hepatocellular carcinoma
• Liver cancer
• Liver disease
• Locoregional therapy
• Staging
• Systemic therapy

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).

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.

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.

Clinical and radiological outcome were not significantly different between the two treatments. Toxicities, however, were more prevalent in the RT group.

• Hepatocellular carcinoma
• Metastasis
• Radiation therapy
• Radiosurgery
• Spine

• Adult
• Aged
• Aged, 80 and over
• Bone Neoplasms/mortality
• Bone Neoplasms/secondary
• Bone Neoplasms/therapy
• Carcinoma, Hepatocellular/mortality
• Carcinoma, Hepatocellular/pathology
• Carcinoma, Hepatocellular/therapy
• Female
• Humans
• Liver Neoplasms/mortality
• Liver Neoplasms/pathology
• Liver Neoplasms/therapy
• Male
• Middle Aged
• Palliative Care/methods
• Prognosis
• Radiotherapy Dosage
• Retrospective Studies
• Survival Rate
• Treatment Outcome

To investigate the outcomes of patients with spinal metastases from hepatocellular carcinoma (HCC), who were treated by stereotactic body radiotherapy (SBRT).

This retrospective study evaluated 23 patients who underwent SBRT from October 2008 to August 2012 for 36 spinal metastases from HCC. SBRT consisted of approximately 2 fractionation schedules, which were 18 to 40 Gy in 1 to 4 fractions for group A lesions (n = 15) and 50 Gy in 10 fractions for group B lesions (n = 21).

The median follow-up period was 7 months (range, 2 to 16 months). Seven patients developed grade 1 or 2 gastrointestinal toxicity, and one developed grade 2 leucopenia. Compression fractures occurred in association with 25% of the lesions, with a median time to fracture of 2 months. Pain relief occurred in 92.3% and 68.4% of group A and B lesions, respectively. Radiologic response (complete and partial response) occurred in 80.0% and 61.9% of group A and B lesions, respectively. The estimated 1-year spinal-tumor progression-free survival rate was 78.5%. The median overall survival period and 1-year overall survival rate were 9 months (range, 2 to 16 months) and 25.7%, respectively.

SBRT for spinal metastases from HCC is well tolerated and effective at providing pain relief and radiologic response. Because compression fractures develop at a high rate following SBRT for spinal metastases from primary HCC, careful follow up of the patient is required.

• Hepatocellular carcinoma
• Spinal metastases
• Stereotactic body radiotherapy

Spinal metastases often severely limit the quality of life by causing severe pain and neurological deficits. The purpose of this study was to evaluate the palliative effect of radiotherapy (RT) for spinal metastases from hepatocellular carcinoma (HCC) and to identify factors predictive of survival in HCC patients with spinal metastases who received RT.

A retrospective analysis was performed on 192 patients with spinal metastases from HCC who received RT.

Of 192 patients with spinal metastases from HCC, an overall pain response to palliative RT occurred in 187 patients (97.4%), with a complete pain response (CR) in 41 patients (21.4%) and a partial response in 151 patients (78.6%). A higher biologically effective dose (BED) and more advanced RT techniques were identified as predictive factors for a CR. The 1- and 2-year overall survival (OS) rates were 18.1% and 6.3%, respectively, and the median survival time was 4.5 months. A long OS was associated with good performance status, controlled primary HCC, absence of extrahepatic metastases, and a higher BED.

RT provided effective palliation for patients with painful spinal metastases from HCC. Our results provide information regarding pain control, survival outcomes, and predictive factors for the prognosis of HCC patients with spinal metastases treated with RT.

• Carcinoma, hepatocellular
• Pain response
• Predictive factors
• Radiotherapy
• Spinal metastases

• Carcinoma, hepatocellular
• Guidelines
• Management

• Carcinoma, Hepatocellular/diagnosis
• Carcinoma, Hepatocellular/therapy
• Evidence-Based Practice
• Hepatectomy
• Humans
• Liver Neoplasms/therapy
• Liver Transplantation
• Primary Prevention
• Republic of Korea
• Secondary Prevention

• Carcinoma
• Guidelines
• Management
• hepatocellular

• Antineoplastic Agents/therapeutic use
• Bile Duct Neoplasms/secondary
• Carcinoma, Hepatocellular/diagnosis
• Carcinoma, Hepatocellular/epidemiology
• Carcinoma, Hepatocellular/prevention & control
• Carcinoma, Hepatocellular/therapy
• Female
• Hepatitis B Vaccines
• Humans
• Liver/pathology
• Liver/surgery
• Liver Neoplasms/diagnosis
• Liver Neoplasms/epidemiology
• Liver Neoplasms/prevention & control
• Liver Neoplasms/therapy
• Liver Transplantation
• Middle Aged
• Neoplasm Staging
• Republic of Korea/epidemiology
• Vaccination

Many patients with hepatocellular carcinoma (HCC) present with advanced disease, not amenable to curative therapies such as surgery, transplantation or radiofrequency ablation. Treatment options for this group of patients include transarterial chemoembolization (TACE) and radiation therapy. Especially TACE, delivering a highly concentrated dose of chemotherapy to tumor cells while minimizing systemic toxicity of chemotherapy, has given favorable results on local control and survival. Radiotherapy, as a therapeutic modality of internal radiation therapy with radioisotopes, has also achieved efficacious tumor control in advanced disease. On the contrary, the role of external beam radiotherapy for HCC has been limited in the past, due to the low tolerance of surrounding normal liver parenchyma. However, technological innovations in the field of radiotherapy treatment planning and delivery, have provided the means of delivering radical doses to the tumor, while sparing normal tissues. Advanced and highly conformal radiotherapy approaches such as stereotactic body radiotherapy and proton therapy, evaluated for efficacy and safety for HCC, report encouraging results. In this review, we present the role of radiotherapy in hepatocellular carcinoma patients not suitable for radical treatment.

• Hepatocellular carcinoma
• Radiotherapy
• Radio-embolization
• Hyperthermia
• Review

The incidence of bone metastases (BMs) from hepatocellular carcinoma (HCC) is relatively low compared to those of other cancers, but it has increased recently, especially in Asian countries. Typically, BMs from HCC appear radiologically as osteolytic, destructive, and expansive components with large, bulky soft-tissue masses. These soft-tissue masses are unique to bone metastases from HCC and often replace the normal bone matrix and exhibit expansive growth. They often compress the peripheral nerves, spinal cord, or cranial nerves, causing not only bone pain but also neuropathic pain and neurological symptoms. In patients with spinal BMs, the consequent metastatic spinal cord compression (MSCC) causes paralysis. Skull base metastases (SBMs) with cranial nerve involvement can cause neurological symptoms. Therefore, patients with bony lesions often suffer from pain or neurological symptoms that have a severe, adverse effect on the quality of life. External-beam radiotherapy (EBRT) can effectively relieve bone pain and neurological symptoms caused by BMs. However, EBRT is not yet widely used for the palliative management of BMs from HCC because of the limited number of relevant studies. Furthermore, the optimal dosing schedule remains unclear, despite clinical evidence to support single-fraction radiation schedules for primary cancers. In this review, we outline data describing palliative EBRT for BMs from HCC in the context of (1) bone pain; (2) MSCC; and (3) SBMs.

• Hepatocellular carcinoma
• Metastasis
• Radiotherapy
• Palliative therapy
• Spinal cord compression
• Skull base metastasis

• Hepatocellular carcinoma
• Jaw bone metastasis
• Mandibular metastasis
• Oral metastasis

• ACS, anorexia-cachexia syndrome
• CBT, cognitive-behavioral therapy
• HBV, hepatitis B virus
• HCC, hepatocellular carcinoma
• HCV, hepatitis C virus
• QOL, quality of life
• RT, radiotherapy
• THC, tetrahydrocannabinol
• WBRT, whole-brain radiation therapy
• hepatitis B virus (HBV)
• hepatitis C (HCV)
• hepatocellular carcinoma (HCC)

• FDG-PET
• SUV ratio
• bone metastasis
• hepatocellular carcinoma
• radiotherapy

• CRT, conformal radiotherapy
• HCC, hepatocellular carcinoma
• IGRT, image guided radiotherapy
• RFA, radiofrequency ablation
• RILD, radiation-induced liver disease
• RT, radiotherapy
• SBRT
• SBRT, stereotactic body radiotherapy
• proton beam therapy
• radiation induced liver disease
• radiotherapy in hepatocellular carcinoma

This paper introduces an innovative treatment for extra-hepatic metastasis of hepatocellular carcinoma. A 71-year-old patient had a stable liver condition following treatment for hepatocellular carcinoma, but later developed symptomatic mediastinal metastasis. This rapidly growing mediastinal mass induced symptoms including cough and hoarseness. Serial sessions of transarterial embolization (TAE) successfully controlled this mediastinal mass with limited side effects. The patient’s survival time since the initial diagnosis of the mediastinal hepatocellular carcinoma was 32 mo, significantly longer than the 12 mo mean survival period of patients with similar diagnoses: metastatic hepatocellular carcinoma and a liver condition with a Child-Pugh class A score. Currently, oral sorafenib is the treatment of choice for metastatic hepatocellular carcinoma. Recent studies indicate that locoregional treatment of extra-hepatic metastasis of hepatocellular carcinomas might also significantly improve the prognosis in patients with their primary hepatic lesions under control. Many effective locoregional therapies for extrahepatic metastasis, including radiation and surgical resection, may provide palliative effects for hepatocellular carcinoma-associated mediastinal metastasis. This case report demonstrates that TAE of metastatic mediastinal hepatocellular carcinoma provided this patient with tumor control and increased survival time. This finding is important as it can potentially provide an alternative treatment option for patients with similar symptoms and diagnoses.

• Embolization
• Hepatocellular carcinoma
• Lymphatic metastasis
• Endosonography
• Mediastinal neoplasm

• Aged
• Carcinoma, Hepatocellular/blood supply
• Carcinoma, Hepatocellular/diagnostic imaging
• Carcinoma, Hepatocellular/secondary
• Carcinoma, Hepatocellular/therapy
• Embolization, Therapeutic
• Ethiodized Oil/administration & dosage
• Humans
• Liver Neoplasms/pathology
• Male
• Mediastinal Neoplasms/blood supply
• Mediastinal Neoplasms/diagnostic imaging
• Mediastinal Neoplasms/secondary
• Mediastinal Neoplasms/therapy
• Time Factors
• Tomography, X-Ray Computed
• Treatment Outcome

• Cadherins/genetics
• Cadherins/metabolism
• Calcium-Binding Proteins/genetics
• Calcium-Binding Proteins/metabolism
• Carcinoma, Hepatocellular/genetics
• Carcinoma, Hepatocellular/metabolism
• Carcinoma, Hepatocellular/pathology
• Cell Line, Tumor
• Core Binding Factor Alpha 3 Subunit/biosynthesis
• Core Binding Factor Alpha 3 Subunit/genetics
• Core Binding Factor Alpha 3 Subunit/metabolism
• Epithelial-Mesenchymal Transition
• Gene Expression Regulation, Neoplastic
• Humans
• Intercellular Signaling Peptides and Proteins/genetics
• Intercellular Signaling Peptides and Proteins/metabolism
• Jagged-1 Protein
• Liver Neoplasms/genetics
• Liver Neoplasms/metabolism
• Liver Neoplasms/pathology
• Membrane Proteins/genetics
• Membrane Proteins/metabolism
• Nuclear Proteins/genetics
• Nuclear Proteins/metabolism
• RNA, Messenger/genetics
• Serrate-Jagged Proteins
• Snail Family Transcription Factors
• Transcription Factors/genetics
• Transcription Factors/metabolism
• Twist-Related Protein 1/genetics
• Twist-Related Protein 1/metabolism
• Vimentin/genetics
• Vimentin/metabolism

• hepatocellular carcinoma
• recurrence
• liver transplantation
• salvage resection
• multidisciplinary
• outcomes

• Carcinoma, Hepatocellular/secondary
• Carcinoma, Hepatocellular/therapy
• Humans
• Liver Neoplasms/pathology
• Liver Neoplasms/surgery
• Liver Transplantation
• Neoplasm Metastasis
• Neoplasm Recurrence, Local/therapy

• P30 CA006973 NCI NIH HHS

This study evaluated the treatment effectiveness and proper radiation dose of helical tomotherapy (HT) in spine oligometastases from gastrointestinal cancers.

From 2006 to 2010, 20 gastrointestinal cancer patients were treated with HT for spine oligometastases (31 spine lesions). The gross tumor volume (GTV) was the tumor evident from magnetic resonance imaging images fused with simulation computed tomography images. Clinical target volume (CTV) encompassed involved vertebral bodies or dorsal elements. We assumed that the planning target volume was equal to the CTV. We assessed local control rate after HT for 31 spine metastases. Pain response was scored by using a numeric pain intensity scale (NPIS, from 0 to 10).

Spine metastatic lesions were treated with median dose of 40 Gy (range, 24 to 51 Gy) and median 5 Gy per fraction (range, 2.5 to 8 Gy) to GTV with median 8 fractions (range, 3 to 20 fraction). Median biologically equivalent dose (BED, α/β = 10 Gy) was 52 Gy₁₀ (range, 37.5 to 76.8 Gy₁₀) to GTV. Six month local control rate for spine metastasis was 90.3%. Overall infield failure rate was 15% and outfield failure rate was 75%. Most patients showed pain relief after HT (93.8%). Median local recurrence free survival was 3 months. BED over 57 Gy₁₀ and oligometastases were identified as prognostic factors associated with improved local progression free survival (p = 0.012, p = 0.041).

HT was capable of delivering higher BED to metastatic lesions in close proximity of the spinal cord. Spine metastases from gastrointestinal tumors were sensitive to high dose radiation, and BED (α/β = 10 Gy) higher than 57 Gy₁₀ could improve local control.

• Helical tomotherapy
• Spine metastasis

• Bone Neoplasms/drug therapy
• Bone Neoplasms/radiotherapy
• Bone Neoplasms/secondary
• Carcinoma, Hepatocellular/pathology
• Carcinoma, Hepatocellular/therapy
• Catheter Ablation
• Combined Modality Therapy
• Femur/pathology
• Femur/surgery
• Fractures, Spontaneous/surgery
• Humans
• Liver Neoplasms/pathology
• Liver Neoplasms/therapy
• Male
• Middle Aged
• Radiotherapy, Adjuvant

• Aged
• Carcinoma, Hepatocellular/diagnosis
• Carcinoma, Hepatocellular/radiotherapy
• Humans
• Liver Neoplasms/diagnosis
• Liver Neoplasms/radiotherapy
• Male
• Skull Neoplasms/radiotherapy
• Skull Neoplasms/secondary
• Treatment Outcome