title: Post-stereotactic radiosurgery brain metastases: a review.
abstract: Stereotactic radiosurgery (SR) is a standard therapy for brain metastases. Radiation necrosis (RN) of the brain is a syndrome of brain coagulative and fibrinoid necrosis and cortical irritation that occurs following radiotherapy. RN following SR peaks in a delayed fashion at 9-12 months postprocedure. Vasogenic cerebral edema secondary to necrosis occurs and can affect surrounding brain function. No definitive non-invasive diagnostic study exists to differentiate post-SR RN from recurrent metastatic tumor. Magnetic resonance (MR) imaging, MR spectroscopy, positron emission tomography, and perfusion-weighted MR imaging have been used to evaluate RN and are discussed. Treatment options for post-SR brain metastases include observation, corticosteroids, pentoxifylline and vitamin E, bevacizumab, radiotherapy, laser-interstitial thermal therapy, and surgical resection.
authors.affiliation: Department of Neurosurgery, Roswell Park Cancer Institute, Buffalo, NY, USA - Andrew.Fabiano@RoswellPark.org.
authors.forename: A J
authors.initials: AJ
authors.lastname: Fabiano
authors.forename: J
authors.initials: J
authors.lastname: Qiu
mesh_terms: D001932:Brain Neoplasms / Q000556:secondary* / Q000601:surgery*; D006801:Humans; D009336:Necrosis / Q000209:etiology; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000628:therapy; D011832:Radiation Injuries / Q000175:diagnosis* / Q000209:etiology*; D016634:Radiosurgery / Q000009:adverse effects*