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01-07-2021 | Metastasis | Clinical Study

The effect of surgery on radiation necrosis in irradiated brain metastases: extent of resection and long-term clinical and radiographic outcomes

Authors: William C. Newman, Jacob Goldberg, Sergio W. Guadix, Samantha Brown, Anne S. Reiner, Katherine Panageas, Kathryn Beal, Cameron W. Brennan, Viviane Tabar, Robert J. Young, Nelson S. Moss

Published in: Journal of Neuro-Oncology | Issue 3/2021

Abstract

Objective

Radiation therapy is a cornerstone of brain metastasis (BrM) management but carries the risk of radiation necrosis (RN), which can require resection for palliation or diagnosis. We sought to determine the relationship between extent of resection (EOR) of pathologically-confirmed RN and postoperative radiographic and symptomatic outcomes.

Methods

A single-center retrospective review was performed at an NCI-designated Comprehensive Cancer Center to identify all surgically-resected, previously-irradiated necrotic BrM without admixed recurrent malignancy from 2003 to 2018. Clinical, pathologic and radiographic parameters were collected. Volumetric analysis determined EOR and longitudinally evaluated perilesional T2-FLAIR signal preoperatively, postoperatively, and at 3-, 6-, 12-, and 24-months postoperatively when available. Rates of time to 50% T2-FLAIR reduction was calculated using cumulative incidence in the competing risks setting with last follow-up and death as competing events. The Spearman method was used to calculate correlation coefficients, and continuous variables for T2-FLAIR signal change, including EOR, were compared across groups.

Results

Forty-six patients were included. Most underwent prior stereotactic radiosurgery with or without whole-brain irradiation (N = 42, 91%). Twenty-seven operations resulted in gross-total resection (59%; GTR). For the full cohort, T2-FLAIR edema decreased by a mean of 78% by 6 months postoperatively that was durable to last follow-up (p < 0.05). EOR correlated with edema reduction at last follow-up, with significantly greater T2-FLAIR reduction with GTR versus subtotal resection (p < 0.05). Among surviving patients, a significant proportion were able to decrease their steroid use: steroid-dependency decreased from 54% preoperatively to 15% at 12 months postoperatively (p = 0.001).

Conclusions

RN resection conferred both durable T2-FLAIR reduction, which correlated with EOR; and reduced steroid dependency.

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Title: The effect of surgery on radiation necrosis in irradiated brain metastases: extent of resection and long-term clinical and radiographic outcomes
Authors: William C. Newman
Jacob Goldberg
Sergio W. Guadix
Samantha Brown
Anne S. Reiner
Katherine Panageas
Kathryn Beal
Cameron W. Brennan
Viviane Tabar
Robert J. Young
Nelson S. Moss
Publication date: 01-07-2021
Publisher: Springer US
Keyword: Metastasis
Published in: Journal of Neuro-Oncology / Issue 3/2021
Print ISSN: 0167-594X
Electronic ISSN: 1573-7373
DOI: https://doi.org/10.1007/s11060-021-03790-y

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

The effect of surgery on radiation necrosis in irradiated brain metastases: extent of resection and long-term clinical and radiographic outcomes

Abstract

Objective

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

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