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Radionecrosis induced by stereotactic radiosurgery of brain metastases: results of surgery and outcome of disease

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Abstract

Sterotactic radiosurgery (SRS) is an effective and commonly employed therapy for metastatic brain tumors. Among complication of this treatment, symptomatic focal cerebral radionecrosis (RN) occurs in 2–10 % of cases. The large diffusion of combined therapies as SRS followed by WBRT and/or CHT, has significantly amplified the number of patients who potentially might be affected by this pathology and neurosurgeons are increasingly called to treat suspected area of RN. Results of surgery of RN in patients with brain metastases are rarely reported in literature, a standardization of diagnostic work-up to correctly identify RN is still lacking and the timing and indications in favour of surgical therapy over medical treatments are not clear as well. In this retrospective study, we review current concept related to RN and analyze the outcome of surgical treatment in a series of 15 patients previously submitted to SRS for brain metastases and affected by suspected radionecrotic lesions. After surgery, all patients except one neurologically improved. No intra-operative complications occurred. Brain edema improved in all patients allowing a reduction or even suspension of corticosteroid therapy. Pure RN was histologically determined in 7 cases; RN and tumor recurrence in the other 8. Overall median survival was 19 months. An aggressive surgical attitude may be advisable in symptomatic patients with suspected cerebral RN, to have histologic confirmation of the lesion, to obtain a long-lasting relief from the mass effect and brain edema and to improve the overall quality of life, sparing a prolonged corticosteroid therapy.

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Acknowledgments

The authors thank Mrs. Mariantonia Carosi MD (Department of Pathology, Istituto Nazionale Tumori “Regina Elena”) for her review of the histologic material, Mrs. Marzia Piccoli and Mrs. Maria Di Santo for the editorial and archives assistance.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Division of Neurosurgery, Istituto Nazionale Tumori Regina Elena, via Elio Chianesi 53, 00144, Rome, Italy

    Stefano Telera, Carmine Maria Carapella, Francesco Crispo & Alfredo Pompili

  2. Division of Medical Oncology A, Istituto Nazionale Tumori Regina Elena, Rome, Italy

    Alessandra Fabi

  3. Department of Neurooncology, Istituto Nazionale Tumori Regina Elena, Rome, Italy

    Andrea Pace

  4. Department of Diagnostic Imaging, Istituto Nazionale Tumori Regina Elena, Rome, Italy

    Antonello Vidiri & Vincenzo Anelli

  5. Division of Radiotherapy, Istituto Nazionale Tumori Regina Elena, Rome, Italy

    Laura Marucci

  6. Biostatistics Unit, Istituto Nazionale Tumori Regina Elena, Rome, Italy

    Isabella Sperduti

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  1. Stefano Telera
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  2. Alessandra Fabi
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  3. Andrea Pace
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  4. Antonello Vidiri
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Correspondence to Stefano Telera.

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Telera, S., Fabi, A., Pace, A. et al. Radionecrosis induced by stereotactic radiosurgery of brain metastases: results of surgery and outcome of disease. J Neurooncol 113, 313–325 (2013). https://doi.org/10.1007/s11060-013-1120-8

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  • DOI: https://doi.org/10.1007/s11060-013-1120-8

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