• Chaejin Lee, Sang-Youl Yoon, Jeong-Hyun Hwang, Seong-Hyun Park, Minjae Kwon, Chaemin Yoon, Kyungyoung Lee, Myong Hun Hahm, and Ki-Su Park.
• Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea.
• World Neurosurg. 2024 Jun 1; 186: e374e381e374-e381.

BackgroundRadiation necrosis (RN) after stereotactic radiosurgery (SRS) in brain metastases has been extensively evaluated, and RN is correlated with various risk factors. However, no study comprehensively analyzed the correlation between RN and the border zones of the brain that are vulnerable to ischemia. We hypothesized that patients with tumors in the border zone are at high risk of RN. Hence, the current study aimed to assess the correlation between border zone lesions and RN, with consideration of other predetermined factors.MethodsThis retrospective study included 117 patients with 290 lesions who underwent Gamma Knife SRS. Radiological and clinical analyses were performed to identify factors possibly correlated with RN. Notably, the lesion location was classified into 2 groups (border zone and nonborder zone) based on the blood supply.ResultsIn total, 22 (18.8%) patients with 22 (7.5%) lesions developed RN. Univariate analysis revealed a significant correlation between RN and external border zone lesions, second course of SRS administered at the same site of the previous SRS, prescribed dose, and tumor volume. Multivariate analysis showed that border zone lesions, second course of SRS at the same site of the previous SRS, and tumor volume were significantly correlated with RN.ConclusionsPatients with tumors in the border zone are at high risk of RN. The potential risks of RN can be attributed hypothetically to hypoperfusion. Hence, the association between RN and border zone lesions seems reasonable.Copyright © 2024 Elsevier Inc. All rights reserved.

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