Brain Metastasis Recurrence Versus Radiation Necrosis

Lee, Dennis; Riestenberg, Robert; Haskell-Mendoza, Aden P.; Bloch, Orin

doi:10.1016/j.nec.2020.06.007

Cited by 31 publications

(23 citation statements)

References 82 publications

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“…Discriminating RNs from recurrence radiologically is often a difficult task [11][12][13][14], but is necessary to find the best therapeutic course of action. Due to diagnostic difficulties on a growing lesion, biopsy remains the gold standard [14], hampered by its invasiveness and with no clear-cut diagnostic criteria, where mixed histology is frequently encountered. This suggest a span of evolution where decreasing irradiated metastatic cells coexist with RN.…”

Section: Discussionmentioning

confidence: 99%

“…However, RNs may resolve spontaneously and require no further therapy. Discriminating RNs from recurrence radiologically is often a difficult task [11–14], but is necessary to find the best therapeutic course of action. Due to diagnostic difficulties on a growing lesion, biopsy remains the gold standard [14], hampered by its invasiveness and with no clear-cut diagnostic criteria, where mixed histology is frequently encountered.…”

Section: Discussionmentioning

confidence: 99%

“…Necrosis is a side effect of SRS and leads to longitudinal inflammatory growth on MR images that may resolve spontaneously. This leads to a diagnostic dilemma due to their similarities on MR imaging with tumor recurrence [11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

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The Growth Laws of Brain Metastases

Ocaña-Tienda

Pérez-Beteta

Molina-García

et al. 2022

Preprint

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Tumor growth is the result of the interplay of complex biological processes in a huge number of individual cells in a changing environment. Effective simple mathematical laws have been shown to describe tumor growth in vitro, or in animal models with bounded-growth dynamics accurately. However, results for human cancers in patients are scarce. The study mined a dataset of 1133 brain metastases (BMs) with longitudinal imaging follow-up, treated with radiosurgery (SRS) to find growth laws for untreated BMs, relapsing treated BMs, and radiation necrosis (RN). Untreated BMs showed sustained growth acceleration, most likely related to the underlying evolutionary dynam- ics. Relapsing BM growth was slower, most probably due to a reduction in tumor heterogeneity after SRS, which may limit the evolutionary possibilities of the tumor. RN lesions had significantly larger growth exponents than relapsing BMs, providing a way to differentiate them from true pro- gression. This may help in solving a problem of clinical relevance, since the first condition may resolve spontaneously, and not require further work-up, while the second requires therapeutic action.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Growth Laws of Brain Metastases

Ocaña-Tienda

Pérez-Beteta

Molina-García

et al. 2022

Preprint

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“…Each lesion treated with SRS theoretically has the potential to fail or develop into radiation necrosis. Radiation necrosis is a known complication of SRS and is characterized by a progressive radiation-induced inflammatory reaction, which can result in neurological symptoms ( 38 , 39 ). It can be a difficult condition to manage for several reasons.…”

Section: Surgical Management Of Recurrent Brain Metatases and Radiati...mentioning

confidence: 99%

Surgical Management of Brain Metastasis: Challenges and Nuances

Ene

Ferguson

2022

Front. Oncol.

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Brain metastasis is the most common type of intracranial tumor. The contemporary management of brain metastasis is a challenging issue and traditionally has carried a poor prognosis as these lesions typically occur in the setting of advanced cancer. However, improvement in systemic therapy, advances in radiation techniques and multimodal therapy tailored to the individual patient, has given hope to this patient population. Surgical resection has a well-established role in the management of brain metastasis. Here we discuss the evolving role of surgery in the treatment of this diverse patient population.

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“…Radiotherapy (RT), in particular stereotactic radiosurgery (SRS), provides an effective means of treating IM, with high rates of local control [ 2 ]. The main limitation of SRS, however, is the risk of radiation necrosis (RN) affecting adjacent brain tissue, which occurs in 5–26% of lesions treated, most commonly 6–11 months after SRS [ 3 ]. In addition to managing symptoms associated with RN, it is important to distinguish RN from true tumor progression (progressive disease, PD), as the management of these two entities differs substantially.…”

Section: Introductionmentioning

confidence: 99%

Improving the diagnosis of radiation necrosis after stereotactic radiosurgery to intracranial metastases with conventional MRI features: a case series

2022

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Background The distinction between true disease progression and radiation necrosis after stereotactic radiosurgery to intracranial metastases is a common, but challenging, clinical scenario. Improvements in systemic therapies are increasing the importance of this distinction. A variety of imaging techniques have been investigated, but the value of any individual technique is limited. Case presentation Assessment should extend beyond simply the appearances of the lesion at a given timepoint, but also consider local anatomy and lesion evolution. Firstly, enlargement of a metastasis is affected by local anatomical boundaries, such as the dural reflections or cerebrospinal fluid spaces. In contrast, the radiation dose administered with stereotactic radiosurgery does not respect these anatomical boundaries and is largely concentric around the treated lesion. Therefore, new, non-contiguous enhancement across such a boundary can be confidently attributed to radiation necrosis. Secondly, the dynamic nature of radiation necrosis may result in a change in lesion shape, with different portions of the lesion simultaneously enlarging and regressing. Regression of part of a lesion indicates radiation necrosis, even if the overall lesion enlarges. This case series describes these two features and provides illustrative clinical examples in which these features allowed a confident diagnosis of radiation necrosis. Conclusions The distinction between true disease progression and radiation necrosis should extend beyond just the appearances of the lesion. More nuanced interpretation incorporating a relationship to anatomical boundaries and a change in shape can improve accurate diagnosis of radiation necrosis.

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Brain Metastasis Recurrence Versus Radiation Necrosis

Cited by 31 publications

References 82 publications

The Growth Laws of Brain Metastases

The Growth Laws of Brain Metastases

Surgical Management of Brain Metastasis: Challenges and Nuances

Improving the diagnosis of radiation necrosis after stereotactic radiosurgery to intracranial metastases with conventional MRI features: a case series

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