Novel Mechanisms and Future Opportunities for the Management of Radiation Necrosis in Patients Treated for Brain Metastases in the Era of Immunotherapy

Vaios, Eugene; Winter, Sebastian; Shih, Helen A.; Dietrich, Jörg; Peters, Katherine B.; Floyd, Scott R.; Kirkpatrick, John P.; Reitman, Zachary J.

doi:10.3390/cancers15092432

Cited by 5 publications

(2 citation statements)

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“…Pathological examination also indicated RN. Numerous previous studies have reported that SRT combined with immunotherapy increased the risk of radiation necrosis ( 31 , 36 , 37 ). Therefore, the concern regarding the potential risk of RN following SRT combined with PD-L1 immunotherapy has increased.…”

Section: Discussionmentioning

confidence: 99%

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Radionecrosis mimicking pseudo‑progression in a patient with lung cancer and brain metastasis following the combination of anti‑PD‑1 therapy and stereotactic radiosurgery: A case report

Wang

Tan

et al. 2023

Oncol Lett

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Brain metastases (BMs) usually develop in patients with non-small cell lung cancer. In addition to systemic therapy, radiation therapy and surgery, anti-programmed cell death-ligand 1 (PD-L1) therapy is another promising clinical anticancer treatment modality. However, the optimal timing and drug-drug interactions of anti-PD-L1 therapy with other combined treatments remain to be elucidated. Treatment with anti-PD-L1 therapy is associated with an increased risk of radionecrosis (RN) regardless of tumor histology. The present study described a case of RN in a patient with lung adenocarcinoma and with BM who received anti-PD-L1 therapy. Before anti-PD-L1 treatment, the patient received whole brain radiotherapy. During durvalumab treatment, the intracranial metastases regressed. The progression of intracranial lesions 9 months later prompted a second-line of therapy with PD-L1 inhibitor durvalumab and stereotactic radiotherapy (SRT). Despite stereotactic irradiation, the lesions progressed further, leading to surgical resection. On examination, RN was detected, but there was no evidence of metastatic lung cancer. The aim of the present study was to present the longitudinal change in magnetic resonance imaging in RN following STR and anti-PD-L1 combined therapy. The atypical image of RN is conditionally important for making an accurate preoperative diagnosis.

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Section: Discussionmentioning

confidence: 99%

“…In the penumbra around the necrotic nucleus, astrocytes, microglia and oligodendrocytes produce factors (e.g. VEGF) that promote cytokine release and increase the permeability of the BBB ( 37 ). However, the mechanisms by which the combination of anti-PD-L1 and radiotherapy promotes RN are still unclear.…”

Section: Discussionmentioning

confidence: 99%