BACKGROUND: Differentiation of tumor recurrence from radionecrosis is a critical step in the follow-up management of patients treated with stereotactic radiosurgery (SRS) for brain metastases. A method that can reliably differentiate tumor recurrence from radiation necrosis using standard MR sequences would be of significant value. METHODS: We analyzed the records of 49 patients with 52 brain metastases treated with SRS who subsequently underwent surgical resection of the same lesion. Forty-seven of the lesions had preoperative MRI available for review (90%), including T1 postcontrast, T2, and fluid attenuated inversion recovery sequences. Pre-SRS and preoperative lesion and edema volumes were manually contoured and measured in a blinded fashion using radiation treatment planning software. A neuropathologist analyzed samples for the presence of tumor and/or radiation necrosis. RESULTS: Longer time between SRS and resection (P < .001) and a larger edema/lesion volume ratio (high T2/T1c, P = .002) were found to be predictive of radionecrosis as opposed to tumor recurrence. Using a cutoff value of 10 for the edema/lesion volume ratio, we were able to predict the presence of tumor with a positive predictive value of 92%, which increased to 100% when looking only at patients who underwent resection <18 months following SRS. CONCLUSIONS: On follow-up imaging, lesions with a high edema/lesion volume ratio and lesions that progress later after SRS are more likely to contain radionecrosis. These indices may help guide clinical decision making in the context of evolving lesions after SRS for brain metastases and thereby avoid unnecessary interventions.
BACKGROUND: Differentiation of tumor recurrence from radionecrosis is a critical step in the follow-up management of patients treated with stereotactic radiosurgery (SRS) for brain metastases. A method that can reliably differentiate tumor recurrence from radiation necrosis using standard MR sequences would be of significant value. METHODS: We analyzed the records of 49 patients with 52 brain metastases treated with SRS who subsequently underwent surgical resection of the same lesion. Forty-seven of the lesions had preoperative MRI available for review (90%), including T1 postcontrast, T2, and fluid attenuated inversion recovery sequences. Pre-SRS and preoperative lesion and edema volumes were manually contoured and measured in a blinded fashion using radiation treatment planning software. A neuropathologist analyzed samples for the presence of tumor and/or radiation necrosis. RESULTS: Longer time between SRS and resection (P < .001) and a larger edema/lesion volume ratio (high T2/T1c, P = .002) were found to be predictive of radionecrosis as opposed to tumor recurrence. Using a cutoff value of 10 for the edema/lesion volume ratio, we were able to predict the presence of tumor with a positive predictive value of 92%, which increased to 100% when looking only at patients who underwent resection <18 months following SRS. CONCLUSIONS: On follow-up imaging, lesions with a high edema/lesion volume ratio and lesions that progress later after SRS are more likely to contain radionecrosis. These indices may help guide clinical decision making in the context of evolving lesions after SRS for brain metastases and thereby avoid unnecessary interventions.
Entities:
Keywords:
brain metastases; magnetic resonance imaging; radionecrosis; stereotactic radiosurgery
Authors: Simeon J Ortega-Lozano; Dolores Martinez del Valle-Torres; Manuel Gómez-Río; Jose M Llamas-Elvira Journal: Clin Nucl Med Date: 2009-08 Impact factor: 7.794
Authors: Hideyuki Kano; Douglas Kondziolka; Javier Lobato-Polo; Oscar Zorro; John C Flickinger; L Dade Lunsford Journal: Neurosurgery Date: 2010-03 Impact factor: 4.654
Authors: Abigail L Stockham; Andrew L Tievsky; Shlomo A Koyfman; Chandana A Reddy; John H Suh; Michael A Vogelbaum; Gene H Barnett; Samuel T Chao Journal: J Neurooncol Date: 2012-05-26 Impact factor: 4.130
Authors: Manuel Gómez-Río; Dolores Martínez Del Valle Torres; Antonio Rodríguez-Fernández; José Manuel Llamas-Elvira; Simeón Ortega Lozano; Carlos Ramos Font; Escarlata López Ramírez; Majed Katati Journal: Eur J Nucl Med Mol Imaging Date: 2004-05-06 Impact factor: 9.236
Authors: George A Alexiou; Andreas D Fotopoulos; Athanasios Papadopoulos; Athanasios P Kyritsis; Konstantinos S Polyzoidis; Spyridon Tsiouris Journal: Ann Nucl Med Date: 2007-07-25 Impact factor: 2.668
Authors: Ines Pires da Silva; Isabella C Glitza; Lauren E Haydu; Romany Johnpulle; Patricia D Banks; George D Grass; Simone M A Goldinger; Jessica L Smith; Ashlyn S Everett; Peter Koelblinger; Rachel Roberts-Thomson; Michael Millward; Victoria G Atkinson; Alexander Guminski; Rony Kapoor; Robert M Conry; Matteo S Carlino; Wei Wang; Mark J Shackleton; Zeynep Eroglu; Serigne Lo; Angela M Hong; Georgina V Long; Douglas B Johnson; Alexander M Menzies Journal: Pigment Cell Melanoma Res Date: 2019-03-03 Impact factor: 4.693
Authors: Timothy J Kaufmann; Marion Smits; Jerrold Boxerman; Raymond Huang; Daniel P Barboriak; Michael Weller; Caroline Chung; Christina Tsien; Paul D Brown; Lalitha Shankar; Evanthia Galanis; Elizabeth Gerstner; Martin J van den Bent; Terry C Burns; Ian F Parney; Gavin Dunn; Priscilla K Brastianos; Nancy U Lin; Patrick Y Wen; Benjamin M Ellingson Journal: Neuro Oncol Date: 2020-06-09 Impact factor: 12.300
Authors: Carlos J Perez-Torres; Liya Yuan; Robert E Schmidt; Keith M Rich; Joseph J H Ackerman; Joel R Garbow Journal: Radiat Oncol Date: 2015-01-31 Impact factor: 3.481
Authors: Gokoulakrichenane Loganadane; Frédéric Dhermain; Guillaume Louvel; Paul Kauv; Eric Deutsch; Cécile Le Péchoux; Antonin Levy Journal: Front Oncol Date: 2018-09-05 Impact factor: 6.244