Long-term risk of radionecrosis and imaging changes after stereotactic radiosurgery for brain metastases Journal Article
| Authors: | Kohutek, Z. A.; Yamada, Y.; Chan, T. A.; Brennan, C. W.; Tabar, V.; Gutin, P. H.; Yang, T. J.; Rosenblum, M. K.; Ballangrud, A.; Young, R. J.; Zhang, Z.; Beal, K. |
| Article Title: | Long-term risk of radionecrosis and imaging changes after stereotactic radiosurgery for brain metastases |
| Abstract: | Radionecrosis is a well-characterized effect of stereotactic radiosurgery (SRS) and is occasionally associated with serious neurologic sequelae. Here, we investigated the incidence of and clinical variables associated with the development of radionecrosis and related radiographic changes after SRS for brain metastases in a cohort of patients with long-term follow up. 271 brain metastases treated with single-fraction linear accelerator-based SRS were analyzed. Radionecrosis was diagnosed either pathologically or radiographically. Univariate and multivariate Cox regression was performed to determine the association between radionecrosis and clinical factors available prior to treatment planning. After median follow up of 17.2 months, radionecrosis was observed in 70 (25.8 %) lesions, including 47 (17.3 %) symptomatic cases. 22 of 70 cases (31.4 %) were diagnosed pathologically and 48 (68.6 %) were diagnosed radiographically. The actuarial incidence of radionecrosis was 5.2 % at 6 months, 17.2 % at 12 months and 34.0 % at 24 months. On univariate analysis, radionecrosis was associated with maximum tumor diameter (HR 3.55, p < 0.001), prior whole brain radiotherapy (HR 2.21, p = 0.004), prescription dose (HR 0.56, p = 0.02) and histology other than non-small cell lung, breast or melanoma (HR 1.85, p = 0.04). On multivariate analysis, only maximum tumor diameter (HR 3.10, p < 0.001) was associated with radionecrosis risk. This data demonstrates that with close imaging follow-up, radionecrosis after single-fraction SRS for brain metastases is not uncommon. Maximum tumor diameter on pre-treatment MR imaging can provide a reliable estimate of radionecrosis risk prior to treatment planning, with the greatest risk among tumors measuring >1 cm. © 2015, Springer Science+Business Media New York. |
| Keywords: | adult; aged; major clinical study; treatment planning; cancer radiotherapy; nuclear magnetic resonance imaging; follow up; melanoma; metastasis; breast cancer; morbidity; retrospective study; necrosis; histology; risk assessment; prescription; brain; radiosurgery; brain metastasis; multivariate analysis; stereotactic radiosurgery; linear accelerator; radiation necrosis; non small cell lung cancer; srs; brain radiography; very elderly; radionecrosis; human; male; female; article |
| Journal Title: | Journal of Neuro-Oncology |
| Volume: | 125 |
| Issue: | 1 |
| ISSN: | 0167-594X |
| Publisher: | Springer |
| Date Published: | 2015-09-01 |
| Start Page: | 149 |
| End Page: | 156 |
| Language: | English |
| DOI: | 10.1007/s11060-015-1881-3 |
| PROVIDER: | scopus |
| PUBMED: | 26307446 |
| PMCID: | PMC4726630 |
| DOI/URL: | |
| Notes: | Export Date: 2 November 2015 -- Source: Scopus |
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