A Comprehensive Review of MR Imaging Changes following Radiosurgery to 500 Brain Metastases

Patel, Toral; McHugh, Brian J.; Bi, Wu; Minja, Frank J.; Knisely, Jonathan; Chiang, Veronica

doi:10.3174/ajnr.a2668

Cited by 151 publications

(98 citation statements)

References 21 publications

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“…Radiographic changes-unrelated to tumor after stereotactic radiosurgery (SRS) for brain metastasis are well documented (1)(2)(3)(4)(5). Classically, these changes manifest clinically months to years after SRS (5,6).…”

Section: Introductionmentioning

confidence: 99%

Possible Interaction of Anti–PD-1 Therapy with the Effects of Radiosurgery on Brain Metastases

Al‐Omari

Cohen

Vortmeyer

et al. 2016

Cancer Immunology Research

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Delayed radiation-induced vasculitic leukoencephalopathy related to stereotactic radiosurgery (SRS) of brain metastases has been reported to manifest clinically 9 to 18 months after treatment. Immune-modulating therapies have been introduced to treatment regimens for malignancies with metastatic predilection to the brain. The interaction of these systemic therapies with other modalities of treatment for brain metastases, namely, SRS, has not been fully characterized. We report two patients with metastatic malignancies to the brain who received SRS followed by immunotherapy with monoclonal antibodies (mAb) to programmed death 1 (PD-1). Both patients appeared to have early clinical and radiologic progression of their treated lesions, which was highly suspicious for tumor progression. Both patients underwent surgical resection of their lesions and the material was submitted for histopathologic examination. Pathologic examination in both cases showed predominantly radiation-induced changes characterized by reactive astrocytosis and vascular wall infiltration by T lymphocytes. The accelerated response to SRS in these two patients was temporally related to the initiation of immunotherapy. We propose a possible biologic interaction between SRS and the PD-1 mAbs. Additionally, awareness of this potential occurrence is critical for accurate interpretation and proper management of clinical and radiologic findings in these patients.

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Section: Introductionmentioning

confidence: 99%

Possible Interaction of Anti–PD-1 Therapy with the Effects of Radiosurgery on Brain Metastases

Al‐Omari

Cohen

Vortmeyer

et al. 2016

Cancer Immunology Research

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show abstract

“…As these are similar findings in tumor recurrence and progression, the differentiation between tumor-related and treatment-related effects is a challenge for conventional imaging including CT and MRI (Fig. 3) (Reddy et al 2013;Patel et al 2011;Essig et al 2011;Kickingereder et al 2013). The timing for treatment-induced changes varies significantly in this respect, and even relative lateoccurring changes can resolve completely.…”

Section: Imaging Findings After Radiation Of the Brainmentioning

confidence: 69%

Brain: Radiotherapy

Essig¹

2015

Imaging of Complications and Toxicity Following Tumor Therapy

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“…Defined as a transient increase in post-SRS tumor contrast enhancement and enlargement that ultimately stabilize or resolve, pseudoprogression can complicate evaluation of disease control post SRS. Up to one-third of patients experience transient increase in tumor volume following SRS [91]. Delayed radiation necrosis following SRS may also be confused with recurrent metastatic disease.…”

Section: Stereotactic Radiosurgery (Srs)mentioning

confidence: 98%