• Alexa Semonche, Nitesh V Patel, Isaac Yang, and Shabbar F Danish.
• Department of Neurological Surgery, Rutgers-RWJ Medical School, New Brunswick, New Jersey, USA.
• World Neurosurg. 2020 Jul 1; 139: e526-e540.

ObjectiveThere is a lack of consensus regarding diagnosis, timing, and method of intervention for progressive enhancement on surveillance imaging after stereotactic radiosurgery (SRS) treatment of brain metastases. We sought to characterize current practices among neurosurgeons in identifying and treating infield tumor recurrence (TR) or radiation necrosis (RN) after SRS for brain metastases.MethodsA voluntary survey was distributed electronically to preidentified neurosurgeons. Results were analyzed using descriptive statistics and χ2 analysis.ResultsA total of 120 participants completed the survey from 72 U.S. and 17 international centers. Most (69.2%) agreed that growth over ≥2 surveillance scans spaced ≥90 days apart identified irreversible progression after SRS for brain metastases. Respondents were evenly divided on the need for tissue biopsy to distinguish between TR and RN. Preferred treatment modality and time frame to initiate treatment of suspected RN differed among neurosurgeons based on SRS case volume for brain metastases (P = 0.002 and P = 0.02, respectively). Neurosurgeons who used magnetic resonance-guided laser interstitial thermal therapy (LITT) for brain metastases were more likely to prefer LITT for suspected RN, whereas those with minimal LITT experience preferred steroids (P < 0.0001). Neurosurgeons in the United States were more likely to prefer LITT for RN (37.3%) compared with international counterparts (0%).ConclusionsOur survey of practicing neurosurgeons highlights areas of controversy in distinguishing between TR and RN and preferred management of suspected RN.Copyright © 2020 Elsevier Inc. All rights reserved.

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