Little Response of Cerebral Metastasis from Hepatocellular Carcinoma to Any Treatments

Abstract

Objective :We retrospectively evaluated the survival outcome of patients with brain metastasis from hepatocellular carcinoma (HCC). Methods : Between 1991 and 2007, a total of 20 patients were diagnosed as having brain metastasis from HCC. The mean age of the patients was 55 ± 13 years, and 17 (85.0%) were men. Seventeen (85.0%) patients had already extracranial metastases. The median time from diagnosis of HCC to brain metastasis was 18.5 months. Fourteen (70.0%) patients had stroke-like presentation due to intracerebral hemorrhage (ICH). Ten (50.0%) patients had single or solitary brain metastasis. Among a total of 34 brain lesions, 31 (91.2%) lesions had the hemorrhagic components. Results : The median survival time was 8 weeks (95% CI, 5.08-10.92), and the actuarial survival rates were 85.0%, 45.0%, 22.5%, and 8.4% at 4, 12, 24, and 54 weeks. Age < 60 years, treatment of the primary and/or extracranial lesions, and recurrent ICH were the possible prognostic factors (p = 0.044, p < 0.001, and p = 0.111, respectively). The median progression-free survival (PFS) time was 3 months (95% CI, 0.95-5.05). Conclusion :The overall survival of the patients with brain metastasis from HCC was very poor with median survival time being only 8 weeks. However, the younger patients less than 60 years and/or no extracranial metastases seem to be a positive prognostic factor. 10.3340/jkns.2010.47.5.325 KEY WORDS : Brain metastasis˙ Hepatocellular carcinoma˙ Survival outcome˙ Prognostic factor.

Tumor markers for early diagnosis for brain metastasis of hepatocellular carcinoma: A case series and literature review for effective loco-regional treatment

“…4,5,[7][8][9] Consistent with previous reports, our case series showed a median survival period of 3 d in the non-treated group although it depends on the timing of the diagnosis. In our cases, Case 1, 2, 5, and 8 showed rapid progression of brain metastases after the diagnosis of extrahepatic metastatic lesions (median of 13.5 months) in lung or lymphnodes.…”

“…In the literature, the time period from intrahepatic lesion until the diagnosis of brain metastasis has been reported to be approximately 20 months, 5,8 whereas our case series showed a median of 30 months (Table 1) and their prognosis is poor, and the survival period after the diagnosis of brain metastasis is a few weeks when no therapy is administered (Table 2). 4,5,[7][8][9] Consistent with previous reports, our case series showed a median survival period of 3 d in the non-treated group although it depends on the timing of the diagnosis.…”

“…[4][5][6][7] The prognosis of these patients is poor with survival period of a few weeks. 4,5,[7][8][9] Therefore, brain metastasis is considered as the terminal state of patients with HCC. In addition, various neurologic symptoms including headache, vomiting, hemiparesis, diplopia, hemianopsia, dysarthria, gait disturbance, and seizure affect their quality of life (QOL), and re-bleeding from the tumors cause a worse prognosis.…”

Leptomeningeal metastasis from hepatocellular carcinoma with other unusual metastases: a case report

“…Previously reported brain metastases from HCC have complicated symptoms such as cranial nerve palsy, but a clear diagnosis of leptomeningeal metastasis using a CSF test was not performed [5,13,14]. The brain metastases in this patient were small and had no significant effect due to mass.…”

Simultaneous multitarget radiotherapy using helical tomotherapy and its combination with sorafenib for pulmonary metastases from hepatocellular carcinoma

“…In this study the most common cause of death was brain hemorrhage, rather than lung failure. Pulmonary metastases in HCC patients are seldom the cause of death, but they suggest the presence of brain metastasis, which can result in brain hemorrhage (associated with a median survival of only 1-3 months) [18]. Hence, we believe that uncontrolled intrahepatic tumors are the most critical problem to address in HCC, and aggressive treatment of intrahepatic tumors contributed in part to the improved OS observed in patients who received sorafenib in this study.…”