Imaging changes over 18 months following stereotactic radiosurgery for brain metastases: both late radiation necrosis and tumor progression can occur

Dylann Fujimoto, Rie von Eyben, Iris C. Gibbs, Steven D. Chang, Gordon Li, Griffith R. Harsh, Steven Hancock, Nancy Fischbein, Scott G. Soltys

Research output: Contribution to journalArticlepeer-review

Abstract

Following stereotactic radiosurgery (SRS) for brain metastases, the median time range to develop adverse radiation effect (ARE) or radiation necrosis is 7–11 months. Similarly, the risk of local tumor recurrence following SRS is OpenSPiltSPi 5% after 18 months. With improvements in systemic therapy, patients are living longer and are at risk for both late (defined as CloseSPigtSPi 18 months after SRS) tumor recurrence and late ARE, which have not previously been well described. An IRB-approved, retrospective review identified patients treated with SRS who developed new MRI contrast enhancement CloseSPigtSPi 18 months following SRS. ARE was defined as stabilization/shrinkage of the lesion over time or pathologic confirmation of necrosis, without tumor. Local failure (LF) was defined as continued enlargement of the lesion over time or pathologic confirmation of tumor. We identified 16 patients, with a median follow-up of 48.2 months and median overall survival of 73.0 months, who had 19 metastases with late imaging changes occurring a median of 32.9 months (range 18.5–63.2 months) after SRS. Following SRS, 12 lesions had late ARE at a median of 33.2 months and 7 lesions had late LF occurring a median of 23.6 months. As patients with cancer live longer and as SRS is increasingly utilized for treatment of brain metastases, the incidence of these previously rare imaging changes is likely to increase. Clinicians should be aware of these late events, with ARE occurring up to 5.3 years and local failure up to 3.8 years following SRS in our cohort.

Original languageEnglish (US)
Pages (from-to)207-212
Number of pages6
JournalJournal of Neuro-Oncology
Volume136
Issue number1
DOIs
StatePublished - Jan 1 2018
Externally publishedYes

Keywords

  • Adverse radiation effect
  • Brain metastases
  • Radiation necrosis
  • Stereotactic radiosurgery
  • Surveillance

ASJC Scopus subject areas

  • Oncology
  • Neurology
  • Clinical Neurology
  • Cancer Research

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