Kim Kyung Su, Kim Kyubo, Chie Eui Kyu, Kim Yoon Jun, Yoon Jung Hwan, Lee Hyo-Suk, Ha Sung W
Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea.
Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea.
Radiat Oncol J. 2015 Mar;33(1):36-41. doi: 10.3857/roj.2015.33.1.36. Epub 2015 Mar 31.
To evaluate the incidence and risk factors of post-treatment intracranial hemorrhage of brain metastases from hepatocellular carcinoma (HCC).
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.
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.
WBRT should be considered to prevent post-treatment hemorrhage in the treatment of brain metastases from HCC.
评估肝细胞癌（HCC）脑转移瘤治疗后颅内出血的发生率及危险因素。
回顾性分析2000年1月至2013年12月期间81例经诊断为HCC脑转移瘤并接受手术、立体定向放射外科手术和/或全脑放疗（WBRT）的患者的病历。
64例（79%）患者在诊断时存在颅内出血。甲胎蛋白（AFP）水平的中位数为1700 ng/mL。20例患者的东部肿瘤协作组（ECOG）体能状态大于2。57例患者接受了WBRT，其他患者接受了手术和/或立体定向放射外科手术，未接受WBRT。在随访期间，发现12例治疗后颅内出血事件。治疗后3个月的出血率为16.1%。多因素分析显示，ECOG体能状态、AFP和WBRT与治疗后出血相关（p分别为0.013、0.013和0.003）。Kaplan-Meier分析显示，未接受WBRT治疗的患者新病灶治疗后3个月的出血率较高，尽管未达到统计学显著性（18.6%对4.6%；p = 0.104）。12例治疗后出血的患者中有10例死于神经系统原因。
在HCC脑转移瘤的治疗中，应考虑采用WBRT以预防治疗后出血。
