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01-10-2015 | Clinical Study

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

Authors: Zachary A. Kohutek, Yoshiya Yamada, Timothy A. Chan, Cameron W. Brennan, Viviane Tabar, Philip H. Gutin, T. Jonathan Yang, Marc K. Rosenblum, Åse Ballangrud, Robert J. Young, Zhigang Zhang, Kathryn Beal

Published in: Journal of Neuro-Oncology | Issue 1/2015

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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Title: Long-term risk of radionecrosis and imaging changes after stereotactic radiosurgery for brain metastases
Authors: Zachary A. Kohutek
Yoshiya Yamada
Timothy A. Chan
Cameron W. Brennan
Viviane Tabar
Philip H. Gutin
T. Jonathan Yang
Marc K. Rosenblum
Åse Ballangrud
Robert J. Young
Zhigang Zhang
Kathryn Beal
Publication date: 01-10-2015
Publisher: Springer US
Published in: Journal of Neuro-Oncology / Issue 1/2015
Print ISSN: 0167-594X
Electronic ISSN: 1573-7373
DOI: https://doi.org/10.1007/s11060-015-1881-3

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

Abstract

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