Radiation necrosis following gamma knife surgery: a case-controlled comparison of treatment parameters and long-term clinical follow up

Chin, Lawrence S.; Ma, Li; DiBiase, Steven J.

doi:10.3171/jns.2001.94.6.0899

Cited by 160 publications

(109 citation statements)

References 14 publications

Supporting

Mentioning

104

Contrasting

Order By: Relevance

“…33 In the setting of SRS without WBRT, the volumes of CNS tissue that receives 10 and 12 Gy have been consistently shown to correlate with risk of RN. 23,28,34 In addition to 10-and 12-Gy volumes, Sneed et al identified capecitabine/fluorouracil use within 1 Advances in Radiation Oncology: OctobereDecember 2016 Recurrent brain metastasis management after SRS affects risk of radiation necrosis month and prior SRS to the same lesion as other independent predictors of ARE after SRS. For locally recurrent metastases treated with repeat SRS, the risk of symptomatic ARE was approximately 20% at 1 year.…”

Section: Discussionmentioning

confidence: 99%

“…20,21 The incidence of RN is directly related to total radiation dose, volume, and fraction size. [22][23][24][25][26][27][28][29][30][31][32] RTOG 90-05 established that for patients who had previously received irradiation for primary brain tumors or brain metastases, maximum tolerated dose of single-fraction SRS was 24 Gy, 18 Gy, and 15 Gy for tumors 20 mm, 21 to 30 mm, and 31 to 40 mm in maximum diameter, respectively, with larger tumor diameter predictive of greater central nervous system (CNS) toxicity. 12 Incidence of RN in RTOG 90-05 was 5% at 6 months after SRS, and increased incrementally with time thereafter, up to 11% at 24 months.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Management Approach for Recurrent Brain Metastases Following Upfront Radiosurgery May Affect Risk of Subsequent Radiation Necrosis

Rae

Gorovets

Rava

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

View full text Add to dashboard Cite

Purpose: Many patients treated with stereotactic radiosurgery (SRS) alone as initial treatment require 1 or more subsequent salvage therapies. This study aimed to determine if commonly used salvage strategies are associated with differing risks of radiation necrosis (RN). Methods and materials: All patients treated with upfront SRS alone for brain metastases at our institution were retrospectively analyzed. Salvage treatment details were obtained for brain failures. Patients who underwent repeat SRS to the same lesion were excluded. RN was determined based on pathological confirmation or advanced brain imaging consistent with RN in a symptomatic patient. Patients were grouped according to salvage treatment and rates of RN were compared via Fisher's exact tests. Results: Of 284 patients treated with upfront SRS alone, 132 received salvage therapy and 44 received multiple salvage treatments. This included 31 repeat SRS alone, 58 whole brain radiation therapy (WBRT) alone, 28 SRS and WBRT, 7 surgery alone, and 8 surgery with adjuvant radiation. With a median follow-up of 10 months, the rate of RN among all patients was 3.17% (9/284), salvaged patients 4.55% (6/132), and never salvaged patients 1.97% (3/152). Receiving salvage therapy did not significantly increase RN risk (P Z .31). Of the patients requiring salvage treatments, the highest RN rate was among patients that had both salvage SRS and WBRT (delivered as separate salvage therapies) (6/28, 21.42%). RN rate in this group was significantly higher than in those treated with repeat SRS alone (0/31), WBRT alone (0/58), surgery alone (0/7), and surgery with adjuvant radiation (0/8). Comparing salvage WBRT doses <30 Gy versus 30 Gy revealed no effect of dose on RN rate. Additionally, among patients who received multiple SRS treatments, number of treated lesions was not predictive of RN incidence. Conclusion: Our results suggest that initial management approach for recurrent brain metastasis after upfront SRS does not affect the rate of RN. However, the risk of RN significantly increases when patients are treated with both repeat SRS and salvage WBRT. Methods to improve prediction of toxicity and optimize patient selection for salvage treatments are needed.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Management Approach for Recurrent Brain Metastases Following Upfront Radiosurgery May Affect Risk of Subsequent Radiation Necrosis

Rae

Gorovets

Rava

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

View full text Add to dashboard Cite

show abstract

“…The normal brain parenchyma Radiosurgery for Temporal Lobe Epilepsy develops DRN more easily than tumors if the identical dose of radiosurgery is delivered. 5) Our Case 6 developed a symptomatic cyst 10 years after treatment. Cyst formation is a well known complication after GKRS for arteriovenous malformation.…”

Section: Discussionmentioning

confidence: 99%

“…15) This 1% line has been reevaluated and is considered to indicate a 3% to 8% risk of radiation necrosis. 5,16) The 3% line is another indicator of the risk of DRN. 9) This line lies below the original 1% risk line, if the target volume is larger than 0.5 ml.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Serious Adverse Effects of Gamma Knife Radiosurgery for Mesial Temporal Lobe Epilepsy

Kawamura

Onishi

Kohda

et al. 2012

Neurol. Med. Chir.(Tokyo)

View full text Add to dashboard Cite

Gamma knife radiosurgery (GKRS) for mesial temporal lobe epilepsy (MTLE) has been proposed as an alternative to surgical resection. We report serious adverse effects of the treatment after follow-up periods over 9 years in 11 patients treated with GKRS between 1997 and 2000. The target volume of the entorhinoamygdalohippocampectomy area was 4.8-17.1 ml. Marginal dose of 20-25 Gy to the 50% isodose was delivered. One patient was drowned after suffering seizure 7 months after GKRS. Two patients did not show any reduction in seizure frequency over 9 and 18 months. Both patients requested open surgery and became seizure-free postoperatively. Four of the other eight patients were classified as Engel's class I within 4 years after GKRS. One of the four patients experienced symptomatic radiation-induced cerebral edema transiently, one developed radiation necrosis and required surgery 5 years after GKRS, and one developed cognitive impairment with hemiparesis 10 years after GKRS. Magnetic resonance (MR) imaging showed a large cyst in the irradiated temporal lobe. This patient recovered fully after the cyst excision. Only one patient became seizure-free and antiepileptic drug-free without symptomatic radiation-induced complications. However, MR imaging revealed abnormal enhancement, cyst formation, and diffuse white matter change in the irradiated temporal lobe 9 years after GKRS. GKRS for MTLE causes adverse effects of delayed seizure remission and symptomatic radiationinduced complications. Therefore, GKRS cannot be considered as an ideal alternative to surgery for MTLE. Long-term follow-up studies including MR imaging with contrast medium are required for the patients even after successful control of seizures.

show abstract

NeXt for neuro‐radiosurgery: A fully automatic approach for necrosis extraction in brain tumor MRI using an unsupervised machine learning technique

Rundo

Militello

Tangherloni

et al. 2017

Int J Imaging Syst Tech

View full text Add to dashboard Cite

Stereotactic neuro‐radiosurgery is a well‐established therapy for intracranial diseases, especially brain metastases and highly invasive cancers that are difficult to treat with conventional surgery or radiotherapy. Nowadays, magnetic resonance imaging (MRI) is the most used modality in radiation therapy for soft‐tissue anatomical districts, allowing for an accurate gross tumor volume (GTV) segmentation. Investigating also necrotic material within the whole tumor has significant clinical value in treatment planning and cancer progression assessment. These pathological necrotic regions are generally characterized by hypoxia, which is implicated in several aspects of tumor development and growth. Therefore, particular attention must be deserved to these hypoxic areas that could lead to recurrent cancers and resistance to therapeutic damage. This article proposes a novel fully automatic method for necrosis extraction (NeXt), using the Fuzzy C‐Means algorithm, after the GTV segmentation. This unsupervised Machine Learning technique detects and delineates the necrotic regions also in heterogeneous cancers. The overall processing pipeline is an integrated two‐stage segmentation approach useful to support neuro‐radiosurgery. NeXt can be exploited for dose escalation, allowing for a more selective strategy to increase radiation dose in hypoxic radioresistant areas. Moreover, NeXt analyzes contrast‐enhanced T1‐weighted MR images alone and does not require multispectral MRI data, representing a clinically feasible solution. This study considers an MRI dataset composed of 32 brain metastatic cancers, wherein 20 tumors present necroses. The segmentation accuracy of NeXt was evaluated using both spatial overlap‐based and distance‐based metrics, achieving these average values: Dice similarity coefficient 95.93% ± 4.23% and mean absolute distance 0.225 ± 0.229 (pixels).

show abstract

Radiation necrosis following gamma knife surgery: a case-controlled comparison of treatment parameters and long-term clinical follow up

Cited by 160 publications

References 14 publications

Management Approach for Recurrent Brain Metastases Following Upfront Radiosurgery May Affect Risk of Subsequent Radiation Necrosis

Management Approach for Recurrent Brain Metastases Following Upfront Radiosurgery May Affect Risk of Subsequent Radiation Necrosis

Serious Adverse Effects of Gamma Knife Radiosurgery for Mesial Temporal Lobe Epilepsy

NeXt for neuro‐radiosurgery: A fully automatic approach for necrosis extraction in brain tumor MRI using an unsupervised machine learning technique

Contact Info

Product

Resources

About