Investigation of the risk factors in the development of radionecrosis in patients with brain metastases undergoing stereotactic radiotherapy.

To investigate the incidence, timing and the factors predictors radionecrosis (RN) development in brain metastases (BMs) undergoing stereotactic radiotherapy (SRT). The study evaluated 245 BMs who exclusively received SRT between 2010 and 2020. RN was detected pathologically or radiologically. The median of follow-up was 22.6 months. RN was detected in 18.4% of the metastatic lesions, and 3.3% symptomatic, 15.1% asymptomatic. The median time of RN was 22.8 months (2.5-39.5), and the rates at 6, 12, and 24 months were 16.8%, 41.4% and 66%, respectively. Univariate analysis revealed that Graded Prognostic Assessment (p = 0.005), Score Index of Radiosurgery (p = 0.015), Recursive Partitioning Analysis (p = 0.011), the presence of primary cancer (p = 0.004) and localization (p = 0.048) significantly increased the incidence of RN. No significant relationship between RN and brain-gross tumor volume doses, planning target volume, fractionation, dose (p > 0.05). Multivariate analysis identified SIR > 6 (OR : 1.30, p = 0.021), primary of breast tumor (OR : 2.33 p = 0.031) and supratentorial localization (OR : 3.64, p = 0.025) as risk factors. SRT is used effectively in BMs. The incidence of RN following SRT is undeniably frequent. It was observed that the incidence rate increased as the follow-up period increased. We showed that brain-GTV doses are not predictive of RN development, unlike other publications. In study, a high SIR score and supratentorial localization were identified as factors that increased the risk of radionecrosis. RN is still a common complication after SRT. Symptomatic RN is a significant cause of morbidity. The causes of RN are still not clearly identified. In many publications, brain dose and volumes have been found to be effective in RN. But, with this study, we found that brain dose volumes and fractionation did not increase the incidence of RN when brain doses were taken into account. The most important factor in the development of RN was found to be related to long survival after SRT. © The Author(s) 2024. Published by Oxford University Press on behalf of the British Institute of Radiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Citation

Bedriye Doğan, Harun Demir, Naciye Işık, Gun Gunalp, Hediye Pınar Günbey, Gökhan Yaprak. Investigation of the risk factors in the development of radionecrosis in patients with brain metastases undergoing stereotactic radiotherapy. The British journal of radiology. 2024 Feb 29

PMID: 38426391

search → result