Stereotactic radiosurgery for brain metastases from hepatocellular carcinoma
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The purpose of this study is to investigate the possible role of stereotactic radiosurgery (SRS) in the management of patients with brain metastases from hepatocellular carcinoma (HCC). Thirty-two consecutive patients with 80 brain metastases from HCC were treated with SRS. Twenty-eight (87.5 %) patients were male, and the mean age of the patients was 54 ± 12 years (range 22–73). Twenty-seven (84.4 %) patients were classified as RTOG RPA Class 2. The mean tumor volume was 6.14 ± 11.3 cm3 (range 0.01–67.3). The mean marginal dose prescribed was 20.1 ± 3.6 Gy (range 10.0–25.0). The median overall survival time after SRS was 11.3 ± 5.8 weeks (95 % CI 0–22.7). A greater total volume of brain metastases (>14 cm3) was the only independent prognostic factor (HR = 2.419; 95 % CI 1.040–5.624; p = 0.040). The actuarial control rate of brain metastases was 51.3 % at 4 months after SRS. The prescribed marginal dose (>18 Gy) was significantly related with the actuarial tumor control (HR = 0.254; 95 % CI 0.089–0.725; p = 0.010). The prognosis of patients with brain metastases from HCC is dismal even with the modern technology of radiosurgery. The marginal dose prescribed should be reevaluated to improve upon the current poor local control rates.
KeywordsStereotactic radiosurgery Hepatocellular carcinoma Brain metastases Stereotactic radiotherapy
This study was supported by grant no. 02-2011-006 from the SNUBH Research Fund.
- 7.Son SH, Choi BO, Ryu MR, Kang YN, Jang JS, Bae SH, Yoon SK, Choi IB, Kang KM, Jang HS (2010) Stereotactic body radiotherapy for patients with unresectable primary hepatocellular carcinoma: dose-volumetric parameters predicting the hepatic complication. Int J Radiat Oncol Biol Phys 78:1073–1080. doi: 10.1016/j.ijrobp.2009.09.009 PubMedCrossRefGoogle Scholar
- 9.Kim WH, Kim DG, Han JH, Paek SH, Chung HT, Park CK, Kim CY, Kim YH, Kim JW, Jung HW (2011) Early significant tumor volume reduction after radiosurgery in brain metastases from renal cell carcinoma results in long-term survival. Int J Radiat Oncol Biol Phys. doi: 10.1016/j.ijrobp.2011.03.044 Google Scholar
- 20.Kress MA, Oermann E, Ewend MG, Hoffman RB, Chaudhry H, Collins B (2013) Stereotactic radiosurgery for single brain metastases from non-small cell lung cancer: progression of extracranial disease correlates with distant intracranial failure. Radiat oncol 8:64. doi: 10.1186/1748-717X-8-64 PubMedCrossRefGoogle Scholar
- 21.Neal MT, Chan MD, Lucas JT Jr, Loganathan A, Dillingham C, Pan E, Stewart JHt, Bourland JD, Shaw EG, Tatter SB, Ellis TL (2013) Predictors of survival, neurologic death, local failure, and distant failure after gamma knife radiosurgery for melanoma brain metastases. World neurosurg. doi: 10.1016/j.wneu.2013.02.025 Google Scholar
- 23.Hiraoka A, Horiike N, Koizumi Y, Tazuya N, Ichiryu M, Nakahara H, Ochi H, Tanabe A, Doi H, Kodama A, Hasebe A, Ichikawa S, Miyamoto Y, Ninomiya T, Asagi A, Matsubara H, Nadano S, Nishizaki O, Umeda M (2008) Brain metastasis from hepatocellular carcinoma treated with a cyber-knife. Intern Med 47:1993–1996PubMedCrossRefGoogle Scholar
- 26.Lee DS, Kim YS, Lee CG, Lim JH, Suh CO, Kim HJ, Cho J (2013) Early volumetric change and treatment outcome of metastatic brain tumors after external beam radiotherapy: differential radiotherapy for brain metastasis. Clinical & translational oncology: official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico. doi: 10.1007/s12094-013-1016-2