title: Treatment Options of Metastatic Brain Tumors from Hepatocellular Carcinoma: Surgical Resection vs. Gamma Knife Radiosurgery vs. Whole Brain Radiation Therapy.
abstract: OBJECTIVE
  Although metastasis of hepatocellular carcinoma to the brain is uncommon, it is associated with a very high mortality rate and most patients usually expire within 1 year after brain metastasis. The aim of this study is to identify the effectiveness of the active interventions such as gamma knife radiosurgery or surgical intervention for these patients.
  
  
  METHODS
  We retrospectively reviewed the medical records and imaging data of 59 patients with metastatic brain tumors from hepatocellular carcinoma from May 2004 to September 2012. The study included patients with available clinical and radiological data who had been diagnosed with metastatic hepatocellular carcinoma of the brain, confirmed by magnetic resonance imaging. The overall survival time was analyzed and compared according to each risk factor.
  
  
  RESULTS
  The mean age at diagnosis of metastatic brain tumor was 52.2 years (14-77). The mean follow-up duration was 13.3 weeks (0.1-117.6). Overall median survival was 4.3 weeks (95% confidence interval, 2.2-6.4). The results from an analysis of clinical factors related to survival revealed that treatment modalities were significantly related to the patient's survival (log rank, p=0.006). Twenty patients (32.8%) experienced tumor bleeding, and the survival time of the patients with tumor bleeding tended to be shorter, although the result was not statistically significant (log rank, p=0.058). Hepatic reserve, by Child-Pugh classification, was grade A in 38 patients (64.4%), grade B in 16 patients (27.1%), and grade C in 5 patients (8.5%), and was significantly related to the patient's survival (log rank, p=0.000).
  
  
  CONCLUSIONS
  Although patients with metastatic brain tumors from hepatocellular carcinoma showed poor survival, active intervention including surgical resection or gamma knife radiosurgery may result in better survival, especially if patients have preserved liver function.
authors.affiliation: Department of Neurosurgery, Yonsei Gamma Knife Center, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Tae Yong
authors.initials: TY
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, Yonsei Gamma Knife Center, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Young Chul
authors.initials: YC
authors.lastname: Na
authors.affiliation: Department of Neurosurgery, Yonsei Gamma Knife Center, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Won Hee
authors.initials: WH
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, Yonsei Gamma Knife Center, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Ji Hee
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Yonsei Gamma Knife Center, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Won Seok
authors.initials: WS
authors.lastname: Chang
authors.affiliation: Department of Neurosurgery, Yonsei Gamma Knife Center, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Hyun Ho
authors.initials: HH
authors.lastname: Jung
authors.affiliation: Department of Neurosurgery, Yonsei Gamma Knife Center, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jong Hee
authors.initials: JH
authors.lastname: Chang
authors.affiliation: Department of Neurosurgery, Yonsei Gamma Knife Center, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jin Woo
authors.initials: JW
authors.lastname: Chang
authors.affiliation: Department of Neurosurgery, Yonsei Gamma Knife Center, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Young Gou
authors.initials: YG
authors.lastname: Park
keywords: Brain tumor; Hepatocellular carcinoma; Metastasis; Radiation therapy; Radiosurgery; Surgery