Predictors of radiation necrosis in long-term survivors after Gamma Knife stereotactic radiosurgery for brain metastases
| Autor: | Ricky E Olson, M.D. Johnson, Inga S. Grills, Peter Y. Chen, K. Meyer, Zaid A. Siddiqui, Andrew M. Baschnagel, Bryan S. Squires, Daniel J. Krauss |
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| Rok vydání: | 2019 |
| Předmět: |
education.field_of_study
medicine.medical_specialty Necrosis business.industry Incidence (epidemiology) medicine.medical_treatment Population Planning target volume Medicine (miscellaneous) Original Articles Gamma knife Radiosurgery Radiation necrosis medicine Treatment factors Radiology medicine.symptom business education |
| Zdroj: | Neurooncol Pract |
| ISSN: | 2054-2585 2054-2577 |
| Popis: | Background The long-term risk of necrosis after radiosurgery for brain metastases is uncertain. We aimed to investigate incidence and predictors of radiation necrosis for individuals with more than 1 year of survival after radiosurgery for brain metastases. Methods Patients who had a diagnosis of brain metastases treated between December 2006 and December 2014, who had at least 1 year of survival after first radiosurgery were retrospectively reviewed. Survival was analyzed using the Kaplan-Meier estimator, and the incidence of radiation necrosis was estimated with death or surgical resection as competing risks. Patient and treatment factors associated with radiation necrosis were also analyzed. Results A total of 198 patients with 732 lesions were analyzed. Thirty-four lesions required salvage radiosurgery and 10 required salvage surgical resection. Median follow-up was 24 months. The estimated median survival for this population was 25.4 months. The estimated per-lesion incidence of radiation necrosis at 4 years was 6.8%. Medical or surgical therapy was required for 60% of necrosis events. Tumor volume and male sex were significant factors associated with radiation necrosis. The per-lesions incidence of necrosis for patients undergoing repeat radiosurgery was 33.3% at 4 years. Conclusions In this large series of patients undergoing radiosurgery for brain metastases, patients continued to be at risk for radiation necrosis throughout their first 4 years of survival. Repeat radiosurgery of recurrent lesions greatly exacerbates the risk of radiation necrosis, whereas treatment of larger target volumes increases the risk modestly. |
| Databáze: | OpenAIRE |
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