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Risk of radiation necrosis after stereotactic radiosurgery for melanoma brain metastasis by anatomical location

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Abstract

Purpose

In this retrospective study, we have explored the anatomical factors that lead to the development of radiation necrosis (RN) in the setting of stereotactic radiosurgery (SRS) for melanoma brain metastases (MBM).

Methods

Between 2014 and 2018, 137 patients underwent SRS for 311 MBM. Lesions were assessed according to anatomical zones: zone 1—peripheral grey-white matter junction and cortical mantle, zone 2—deep white matter, including tumours located at base of sulci, zone 3—tumours adjacent to ependymal lining or in deep locations such as brainstem, basal ganglia and thalamus. Other anatomical factors including lobes, medial-peripheral, supra or infratentorial locations were also recorded.

Results

In all, 12.4% (n = 17) of patients and 6.1% (n = 20) of lesions developed RN, actuarial incidence of RN at 12 and 24 months was 10% and 14.2% respectively. Zone 2 lesions recorded the highest rate of development of RN (n = 7/19; 36%), zone 3 (N = 4/24; 16%) and zone 1 (n = 9/268; 3%). Five of 17 patients developed symptomatic RN and 7/17 patients underwent surgery for RN.

Conclusion

This study raises awareness of the increased likelihood of deep lesions particularly in white matter structures to develop RN after SRS. Further studies including larger cohorts would be useful in identifying statistical differences in the rate of development of RN in different anatomical zones.

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Authors and Affiliations

  1. Royal Prince Alfred Hospital, Camperdown, NSW, Australia

    Siujoon Choi, Angela Hong & Brindha S. Shivalingam

  2. Chris O’Brien Lifehouse, Camperdown, NSW, Australia

    Angela Hong & Brindha S. Shivalingam

  3. Melanoma Institute Australia, North Sydney, NSW, Australia

    Angela Hong, Tim Wang, Seringe Lo, Bi Chen, Ines Silva, Rony Kapoor, Edward Hsiao, Gerald B. Fogarty, Matteo S. Carlino, Alexander M. Menzies, Georgina V. Long & Brindha S. Shivalingam

  4. Mater Hospital, North Sydney, NSW, Australia

    Rony Kapoor, Gerald B. Fogarty, Alexander M. Menzies, Georgina V. Long & Brindha S. Shivalingam

  5. Royal North Shore Hospital, St Leonards, NSW, Australia

    Edward Hsiao, Alexander M. Menzies & Georgina V. Long

  6. Crown Princess Mary Cancer Centre, Westmead, NSW, Australia

    Tim Wang & Matteo S. Carlino

  7. Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia

    Angela Hong, Tim Wang, Seringe Lo, Gerald B. Fogarty, Matteo S. Carlino, Alexander M. Menzies & Georgina V. Long

Authors
  1. Siujoon Choi
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  2. Angela Hong
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  3. Tim Wang
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  4. Seringe Lo
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  5. Bi Chen
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  6. Ines Silva
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  7. Rony Kapoor
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  8. Edward Hsiao
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  10. Matteo S. Carlino
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  11. Alexander M. Menzies
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  12. Georgina V. Long
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  13. Brindha S. Shivalingam
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Corresponding author

Correspondence to Siujoon Choi.

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Conflict of interest

S. Choi, A. Hong, T. Wang, S. Lo, B. Chen, I. Silva, R. Kapoor, E. Hsiao, G. B. Fogarty, M. S. Carlino, A. M. Menzies, G. V. Long and B. S. Shivalingam declare that they have no competing interests. We confirm that this manuscript is original and is not being considered for publication elsewhere. All figures and tables in this manuscript have been created by the authors of this manuscript.

Ethical standards

All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional (granted by the Melanoma Institute of Australia) and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Choi, S., Hong, A., Wang, T. et al. Risk of radiation necrosis after stereotactic radiosurgery for melanoma brain metastasis by anatomical location. Strahlenther Onkol 197, 1104–1112 (2021). https://doi.org/10.1007/s00066-021-01798-x

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  • DOI: https://doi.org/10.1007/s00066-021-01798-x

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