Brain Metastasis Recurrence Versus Radiation Necrosis: Evaluation and Treatment

Dennis Lee, Robert A. Riestenberg, Aden Haskell-Mendoza, Orin Bloch

Research output: Contribution to journalReview articlepeer-review


Radiation necrosis (RN) occurs in 5% to 25% of patients with brain metastases treated with stereotactic radiosurgery. RN must be distinguished from recurrent tumor to determine appropriate treatment. Stereotactic biopsy remains the gold standard for identifying RN. Initial treatment of RN often involves management of edema using corticosteroids, antiangiogenic therapies, and hyperbaric oxygen therapy. For refractory symptoms, surgical resection can be considered. Minimally invasive stereotactic laser ablation has the benefit of providing tissue diagnosis and treating RN or recurrent tumor with similar efficacy. Laser ablation should be considered for lesions in need of intervention where the diagnosis requires tissue confirmation.

Original languageEnglish (US)
JournalNeurosurgery Clinics of North America
StateAccepted/In press - 2020


  • Brain metastases
  • Radiation necrosis
  • Radionecrosis
  • Recurrence
  • Stereotactic radiosurgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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