title: Gamma Knife surgery for treating brain metastases arising from hepatocellular carcinomas.
abstract: OBJECTIVE
  Brain metastases from hepatocellular carcinoma (HCC) are rare, and the evidence of the effectiveness of Gamma Knife surgery (GKS) in this disease is lacking. The authors report their institutional experience with GKS in patients with brain metastases from HCCs.
  
  
  METHODS
  The authors retrospectively reviewed the medical records of 73 consecutive patients who had a combined total of 141 brain metastases arising from HCCs and were treated with GKS. Sixty-four (87.7%) patients were male, and the mean age of the patients was 52.5 years (range 30-79 years). The mean tumor volume was 7.35 cm(3) (range 0.19-33.7 cm(3)). The median margin dose prescribed was 23 Gy (range 15-32 Gy). Univariate and multivariate survival analyses were performed to identify possible prognostic factors of outcomes.
  
  
  RESULTS
  The estimated rate of local tumor control was 79.6% at 3 months after GKS. The median overall survival time after GKS was 16 weeks. The actuarial survival rates were 76.7%, 58.9%, and 26.0% at 4, 12, and 24 weeks after GKS, respectively. In the univariate analysis, an age of ≤ 65 years, Child-Pugh Class A (pertaining to liver function), high Karnofsky Performance Scale score (≥ 70), and low Radiation Therapy Oncology Group recursive partitioning analysis class (I or II) were positively associated with the survival times of patients. No statistically significant variable was identified in the multivariate analysis.
  
  
  CONCLUSIONS
  Although survival was extremely poor in patients with brain metastases from HCCs, GKS showed acceptable local tumor control at 3 months after the treatment. The authors suggest that GKS represents a noninvasive approach that may provide a valuable option for treating patients with brain metastases from HCCs.
authors.affiliation: Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan; and.
authors.forename: Eun Suk
authors.initials: ES
authors.lastname: Park
authors.forename: Do Hoon
authors.initials: DH
authors.lastname: Kwon
authors.forename: Jun Bum
authors.initials: JB
authors.lastname: Park
authors.forename: Do Hee
authors.initials: DH
authors.lastname: Lee
authors.forename: Young Hyun
authors.initials: YH
authors.lastname: Cho
authors.forename: Jeong Hoon
authors.initials: JH
authors.lastname: Kim
authors.forename: Chang Jin
authors.initials: CJ
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000556:secondary / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011829:Radiation Dosage; D016634:Radiosurgery / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: AFP = alpha fetoprotein; GKS = Gamma Knife surgery; Gamma Knife surgery; HCC = hepatocellular carcinoma; KPS = Karnofsky Performance Scale; RPA = recursive partitioning analysis; RTOG = Radiation Therapy Oncology Group; SRS = stereotactic radiosurgery; WBRT = whole-brain radiotherapy; hepatocellular carcinomas; neoplasm metastases; oncology; radiosurgery; stereotactic radiosurgery