• Michelle M Williams, Arian K Sohrabi, Carol A Kittel, Jaclyn J White, Christina K Cramer, Claire M Lanier, Jimmy Ruiz, Fei Xing, Wencheng Li, Christopher T Whitlow, Stephen B Tatter, Michael D Chan, and Adrian W Laxton.
• Department of Neurosurgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
• World Neurosurg. 2024 Jan 1; 181: e453e458e453-e458.

ObjectiveImaging changes after stereotactic radiosurgery (SRS) can occur for years after treatment, although the available data on the incidence of tumor progression and adverse radiation effects (ARE) are generally limited to the first 2 years after treatment.MethodsA single-institution retrospective review was conducted of patients who had >18 months of imaging follow-up available. Patients who had ≥1 metastatic brain lesions treated with Gamma Knife SRS were assessed for the time to radiographic progression. Those with progression ≥18 months after the initial treatment were included in the present study. The lesions that progressed were characterized as either ARE or tumor progression based on the tissue diagnosis or imaging characteristics over time.ResultsThe cumulative incidence of delayed imaging radiographic progression was 35% at 5 years after the initial SRS. The cumulative incidence curves of the time to radiographic progression for lesions determined to be ARE and lesions determined to be tumor progression were not significantly different statistically. The cumulative incidence of delayed ARE and delayed tumor progression was 17% and 16% at 5 years, respectively. Multivariate analysis indicated that the number of metastatic brain lesions present at the initial SRS was the only factor associated with late radiographic progression.ConclusionsThe timing of late radiographic progression does not differ between ARE and tumor progression. The number of metastatic brain lesions at the initial SRS is a risk factor for late radiographic progression.Copyright © 2023. Published by Elsevier Inc.

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