1. The effect of surgery on radiation necrosis in irradiated brain metastases: extent of resection and long-term clinical and radiographic outcomes
- Author
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Nelson S Moss, William C Newman, Samantha Brown, Katherine S. Panageas, Anne S. Reiner, Kathryn Beal, Jacob L. Goldberg, Robert J. Young, Viviane Tabar, Cameron Brennan, and Sergio W Guadix
- Subjects
Cancer Research ,medicine.medical_specialty ,medicine.medical_treatment ,Radiography ,Radiosurgery ,Malignancy ,Article ,Necrosis ,03 medical and health sciences ,0302 clinical medicine ,Edema ,medicine ,Humans ,Cumulative incidence ,Radiation Injuries ,Retrospective Studies ,Brain Neoplasms ,business.industry ,Cancer ,medicine.disease ,Surgery ,Radiation therapy ,Treatment Outcome ,Neurology ,Oncology ,030220 oncology & carcinogenesis ,Neurology (clinical) ,Neoplasm Recurrence, Local ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Brain metastasis - Abstract
OBJECTIVE: Radiation therapy is a cornerstone of brain metastasis (BrM) management but carries the risk of radiation necrosis (RN), which can require resection for palliation or diagnosis. We sought to determine the relationship between extent of resection (EOR) of pathologically-confirmed RN and postoperative radiographic and symptomatic outcomes. METHODS: A single-center retrospective review was performed at an NCI-designated Comprehensive Cancer Center to identify all surgically-resected, previously-irradiated necrotic BrM without admixed recurrent malignancy from 2003-2018. Clinical, pathologic and radiographic parameters were collected. Volumetric analysis determined EOR and longitudinally evaluated perilesional T2-FLAIR signal preoperatively, postoperatively, and at 3-, 6-, 12-, and 24-months postoperatively when available. Rates of time to 50% T2-FLAIR reduction was calculated using cumulative incidence in the competing risks setting with last follow-up and death as competing events. The Spearman method was used to calculate correlation coefficients, and continuous variables for T2-FLAIR signal change, including EOR, were compared across groups. RESULTS: Forty-six patients were included. Most underwent prior stereotactic radiosurgery with or without whole-brain irradiation (n=42, 91%). Twenty-seven operations resulted in gross-total resection (59%; GTR). For the full cohort, T2-FLAIR edema decreased by a mean of 78% by 6 months postoperatively that was durable to last follow-up (p
- Published
- 2021