title: [Brain radiation necrosis after stereotactic radiotherapy of the resection cavity for intracranial metastases: analysis of the literature from four cases].
abstract: Stereotactic hypofractionated radiotherapy after resection of brain metastasis is an alternative to whole brain radiotherapy. A high dose per fraction is associated with a risk of radiation necrosis. We present four cases of confirmed histological radiation necrosis. Differentiating recurrent tumour from radiation necrosis in this scenario is challenging. An enhancing area in magnetic resonance imaging (MRI) with a "cut bell pepper" appearance may suggest radiation necrosis. Advanced imaging modalities such as perfusion MR imaging and positron emission tomography can be useful. Dosimetric predictors of the occurrence of radiation necrosis after stereotactic hypofractionated radiotherapy are poorly understood and require prospective studies on larger cohorts.
authors.affiliation: Service de radiothérapie, institut de cancérologie de l'Ouest, boulevard Jacques-Monod, 44805 Saint-Herblain, France. Electronic address: meladore@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Doré
authors.affiliation: Service de radiothérapie, centre Henri-Becquerel, rue d'Amiens, 76000 Rouen, France.
authors.forename: L
authors.initials: L
authors.lastname: Lefebvre
authors.affiliation: Service de radiothérapie, institut de cancérologie de l'Ouest, boulevard Jacques-Monod, 44805 Saint-Herblain, France.
authors.forename: G
authors.initials: G
authors.lastname: Delpon
authors.affiliation: Service de radiothérapie, institut de cancérologie de l'Ouest, boulevard Jacques-Monod, 44805 Saint-Herblain, France.
authors.forename: F
authors.initials: F
authors.lastname: Thillays
mesh_terms: D001921:Brain / Q000473:pathology / Q000528:radiation effects*; D001932:Brain Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D002277:Carcinoma / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D016371:Cranial Irradiation / Q000009:adverse effects*; D019583:Dose Fractionation, Radiation; D006801:Humans; D008279:Magnetic Resonance Imaging; D008545:Melanoma / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D009336:Necrosis; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D049268:Positron-Emission Tomography; D011183:Postoperative Complications / Q000209:etiology; D011832:Radiation Injuries / Q000175:diagnosis* / Q000473:pathology; D016634:Radiosurgery / Q000009:adverse effects*
keywords: Brain metastasis; Irradiation en conditions stéréotaxiques; Métastase cérébrale; Radiation necrosis; Radionécrose; Radiosurgery