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Long-term risk of radionecrosis and imaging changes after stereotactic radiosurgery for brain metastases

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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.

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Authors and Affiliations

  1. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA

    Zachary A. Kohutek, Yoshiya Yamada, Timothy A. Chan, T. Jonathan Yang & Kathryn Beal

  2. Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Timothy A. Chan & Cameron W. Brennan

  3. Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Cameron W. Brennan, Viviane Tabar & Philip H. Gutin

  4. Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Marc K. Rosenblum

  5. Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Åse Ballangrud

  6. Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Robert J. Young

  7. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Zhigang Zhang

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  1. Zachary A. Kohutek
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  2. Yoshiya Yamada
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Correspondence to Kathryn Beal.

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Kohutek, Z.A., Yamada, Y., Chan, T.A. et al. Long-term risk of radionecrosis and imaging changes after stereotactic radiosurgery for brain metastases. J Neurooncol 125, 149–156 (2015). https://doi.org/10.1007/s11060-015-1881-3

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  • DOI: https://doi.org/10.1007/s11060-015-1881-3

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