Intracranial metastasis of hepatocellular carcinoma: review of 45 cases.

Background: Although extrahepatic metastasis of hepatocellular carcinoma (HCC) is not uncommon, intracranial metastasis is relatively rare.

Methods: We reviewed HCC cases admitted in our hospital in the past 16 years, and there were only 45 cases with clinically diagnosed intracranial metastasis. Their age ranged from 14 to 82 years with the peak in the 3rd and 4th decades, which is much younger than the average age of the HCC patients.

Results: Of the 45 patients, 39 (39/45, 86.7%) had hepatitis B related and 20 (20/45, 44.4%) had cirrhosis of the liver. Intracranial hemorrhage as the initial manifestation was common in our series (18/45, 40%). Hemiparesis was found in 14 cases, scalp mass in 9 cases, headache in 13 cases, diplopia in 3 cases (1 ultimately became totally blind), homonymous hemianopsia in 2 cases, dysarthria in 3 cases, gait disturbance in 1 case, seizure in 3 cases, and aphasia in 1 case. The modes of therapy for patients with intracranial metastasis included conservative medical treatment only or surgical excision and/or radiotherapy. In this series, elevated AFP was noted in 32 patients, and alpha fetoprotein higher than several thousands was even noted in 30 patients; extraordinary high level (>70000) was also seen in more than one-half of the patients.

Conclusions: HCC patients with intracranial metastasis presented a very poor prognosis. In general, they deteriorated rapidly and expired without active treatment. Surgical excision of the intracranial metastatic mass, followed by radiotherapy, can improve the life quality and prolong survival time.