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- A J Fabiano and J Qiu.
- Department of Neurosurgery, Roswell Park Cancer Institute, Buffalo, NY, USA - Andrew.Fabiano@RoswellPark.org.
- J Neurosurg Sci. 2015 Jun 1; 59 (2): 157-67.
AbstractStereotactic radiosurgery (SR) is a standard therapy for brain metastases. Radiation necrosis (RN) of the brain is a syndrome of brain coagulative and fibrinoid necrosis and cortical irritation that occurs following radiotherapy. RN following SR peaks in a delayed fashion at 9-12 months postprocedure. Vasogenic cerebral edema secondary to necrosis occurs and can affect surrounding brain function. No definitive non-invasive diagnostic study exists to differentiate post-SR RN from recurrent metastatic tumor. Magnetic resonance (MR) imaging, MR spectroscopy, positron emission tomography, and perfusion-weighted MR imaging have been used to evaluate RN and are discussed. Treatment options for post-SR brain metastases include observation, corticosteroids, pentoxifylline and vitamin E, bevacizumab, radiotherapy, laser-interstitial thermal therapy, and surgical resection.
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