title: Long-term risk of radionecrosis and imaging changes after stereotactic radiosurgery for brain metastases.
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.
authors: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA.
authors: Zachary A
authors: ZA
authors: Kohutek
authors: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA.
authors: Yoshiya
authors: Y
authors: Yamada
authors: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA.|Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors: Timothy A
authors: TA
authors: Chan
authors: Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors: Cameron W
authors: CW
authors: Brennan
authors: Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors: Viviane
authors: V
authors: Tabar
authors: Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors: Philip H
authors: PH
authors: Gutin
authors: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA.
authors: T Jonathan
authors: TJ
authors: Yang
authors: Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors: Marc K
authors: MK
authors: Rosenblum
authors: Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors: Åse
authors: Å
authors: Ballangrud
authors: Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors: Robert J
authors: RJ
authors: Young
authors: Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors: Zhigang
authors: Z
authors: Zhang
authors: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA. bealk@mskcc.org.
authors: Kathryn
authors: K
authors: Beal
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001932:Brain Neoplasms / Q000556:secondary* / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000209:etiology / Q000473:pathology; D011832:Radiation Injuries / Q000209:etiology* / Q000473:pathology; D016634:Radiosurgery / Q000009:adverse effects*; D055815:Young Adult
keywords: Brain; Metastasis; Necrosis; Radionecrosis; Radiosurgery; SRS