From the Guidelines

The presence of brain metastasis in hepatocellular carcinoma (HCC) patients significantly worsens their prognosis.

The prognosis and treatment decision for HCC patients with brain metastasis is generally poor and dependent on the extent of metastatic disease, severity of underlying cirrhosis, and performance status of the patient 1.
Patients with limited extrahepatic tumor burden, including brain metastasis, and concurrent macrovascular invasion often experience rapid tumor progression with disease-related symptoms.
The treatment approach for HCC patients with brain metastasis may involve locoregional therapies (LRTs), but the evidence supporting their routine use is limited, and the prognosis remains poor regardless of the treatment strategy used 1.
The presence of brain metastasis in HCC patients complicates treatment decisions and often requires a multidisciplinary approach to manage the disease and its symptoms.

From the Research

The implications of HCC with brain metastasis are severe and associated with a poor prognosis. Key points to consider include:

Brain metastases from HCC are rare, with an incidence rate ranging from 0.47% to 0.9% 2, 3, 4
The median survival after diagnosis of brain metastasis is extremely poor, ranging from 3 months to 6.8 weeks 2, 3, 4, 5
Prognostic factors for survival include treatment modality, number of brain lesions, alpha-fetoprotein, ECOG performance score, recursive partitioning analysis (RPA) class, and Child-Pugh classification 2, 3, 4, 5
Patients with a low RPA class may benefit from aggressive treatment, including brain radiotherapy or surgical resection 2, 4
Intracranial hemorrhage is a common complication, occurring in 39.5% to 54.8% of patients with brain metastases from HCC 3, 4, 5

Clinical features and prognostic factors of brain metastases from HCC include:

Median age at diagnosis of brain metastasis: 48.5 to 54 years 2, 3, 4
Male predominance: 76% to 80.5% of patients are male 2, 3, 4
Hepatitis B infection: 73.2% to 85.5% of patients have hepatitis B 3, 4
Extracranial metastases: 73.2% to 80.5% of patients have extracranial metastases at diagnosis of brain metastasis 4
Treatment modalities: whole-brain radiation therapy, stereotactic radiosurgery, surgical resection, and best supportive care 2, 3, 4, 5

Current and future management strategies for brain metastases from HCC include:

Multidisciplinary approaches: surgery, whole-brain radiation therapy, and stereotactic radiosurgery 6
Novel treatments: target therapy and immunotherapy may provide an opportunity to improve survival 6
Optimal treatment selection: requires consideration of prognostic factors, including RPA class, number of brain lesions, and liver function 2, 3, 4, 5