title: Post-treatment intracranial hemorrhage of brain metastases from hepatocellular carcinoma.
abstract: OBJECTIVE
  To evaluate the incidence and risk factors of post-treatment intracranial hemorrhage of brain metastases from hepatocellular carcinoma (HCC).
  
  
  METHODS
  Medical records of 81 patients who have been diagnosed of brain metastases from HCC and underwent surgery, radiosurgery and/or whole brain radiotherapy (WBRT) between January 2000 and December 2013 were retrospectively reviewed.
  
  
  RESULTS
  Intracranial hemorrhage was present in 64 patients (79%) at the time of diagnosis. Median value of alpha-fetoprotein (AFP) level was 1,700 ng/mL. The Eastern Cooperative Oncology Group (ECOG) performance status for 20 patients was greater than 2. Fifty-seven patients underwent WBRT and the others were treated with surgery and/or radiosurgery without WBRT. During follow-up, 12 events of intracranial hemorrhage after treatment were identified. Three-month post-treatment hemorrhage rate was 16.1%. Multivariate analyses revealed that ECOG performance status, AFP, and WBRT were associated with post-treatment hemorrhage (p = 0.013, 0.013, and 0.003, respectively). Kaplan-Meier analysis showed that 3-month post-treatment hemorrhage rate of new lesion was higher in patients treated without WBRT, although statistical significance was not reached. (18.6% vs. 4.6%; p = 0.104). Ten of 12 patients with post-treatment hemorrhage died with neurologic cause.
  
  
  CONCLUSIONS
  WBRT should be considered to prevent post-treatment hemorrhage in the treatment of brain metastases from HCC.
authors: Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea.
authors: Kyung Su
authors: KS
authors: Kim
authors: Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea.
authors: Kyubo
authors: K
authors: Kim
authors: Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea.
authors: Eui Kyu
authors: EK
authors: Chie
authors: Departrment of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors: Yoon Jun
authors: YJ
authors: Kim
authors: Departrment of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors: Jung Hwan
authors: JH
authors: Yoon
authors: Departrment of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors: Hyo-Suk
authors: HS
authors: Lee
authors: Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea.
authors: Sung W
authors: SW
authors: Ha
keywords: Brain metastases; Hepatocellular carcinoma; Intracranial hemorrhages