title: Radionecrosis after stereotactic radiotherapy for brain metastases.
abstract: Radionecrosis (RN) represents the main complication of stereotactic radiotherapy (SRT) for brain metastases. It may be observed in up to 34% of cases at 24 months after treatment and associated with significant morbidity in 10-17%.
  
  
  
  Our aim is to discuss the results of original studies on RN related to SRT for brain metastases. Expert commentary: Although the development of RN is unpredictable, larger volume of the lesion, prior whole brain irradiation, and higher dose of radiation represent the major risk factors. RN appears on MRI as contrast-enhancing necrotic lesions, surrounded by edema, occurring at least 3 months after SRT, localized within fields of irradiation. No firm criteria are established. Surgery can provide symptomatic relief but is associated with a risk of complications. Corticosteroids are considered the standard of care treatment, despite limited efficacy and many adverse effects. Bevacizumab represents another interesting option that needs to be validated.
authors.affiliation: a Lille University, Inserm U1191 PRISM , Villeneuve d'Ascq , France.|b Neuro-oncology, Department of Neurosurgery , University Hospital , Lille , France.|c Breast Unit, Department of Medical Oncology , Oscar Lambret Center , Lille , France.
authors.forename: E
authors.initials: E
authors.lastname: Le Rhun
authors.affiliation: d Department of Radiotherapy , Gustave Roussy University Hospital , Villejuif , France.
authors.forename: F
authors.initials: F
authors.lastname: Dhermain
authors.affiliation: e Department of Radiation Oncology , Institut de Cancérologie de Lorraine , Vandoeuvre Les Nancy , France.|f UMR 7365 CNRS - ImoPA - Université de Lorraine , Vandoeuvre Les Nancy , France.
authors.forename: G
authors.initials: G
authors.lastname: Vogin
authors.affiliation: g Department of Neurosurgery , Univ. Lille, Inserm, CHU Lille, U1189 - ONCO THAI - Image Assisted Laser Therapy for Oncology , Lille , France.
authors.forename: N
authors.initials: N
authors.lastname: Reyns
authors.affiliation: h Department of Neurosurgery , Clairval Hospital Center, Generale de Sante , Marseille , France.|i INSERM, UMR 911, CRO2, Faculté de Médecine , Aix-Marseille University , Marseille , France.
authors.forename: P
authors.initials: P
authors.lastname: Metellus
mesh_terms: D001921:Brain; D001932:Brain Neoplasms; D006801:Humans; D009336:Necrosis; D011832:Radiation Injuries; D016634:Radiosurgery
keywords: Radionecrosis; brain metastases; radiation necrosis; radiosurgery; stereotactic radiotherapy