Artikel
Differences in risk factors for radiation necrosis after radiosurgery of malignant vs. non-malignant intracranial neoplasms
Unterschiede bei den Risikofaktoren für Strahlennekrosen zwischen malignen und nicht-malignen intrakraniellen Neoplasien nach radiochirurgischer Behandlung
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Autoren
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Matthias Demetz
- Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Österreich
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Johannes Kerschbaumer
- Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Österreich
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Aleksandrs Krigers
- Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Österreich
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Meinhard Nevinny-Stickel
- Medizinische Universität Innsbruck, Radiotherapy/Radiation Oncology, Innsbruck, Österreich
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Claudius Thomé
- Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Österreich
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Christian F. Freyschlag
- Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Österreich
| Veröffentlicht: | 4. Juni 2021 |
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Gliederung
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Objective: Radiosurgery is an interdisciplinary treatment concept for intracranial neoplasms of different biological behavior. Radiation necrosis is a possible complication, but there are still only few known risk factors for its development. The aim of this study was to compare the incidence and risk factors of radiation necrosis between malignant and non-malignant tumors after radiosurgery.
Methods: Patients treated with single staged radiosurgery between January 2004 and November 2020 were included. The clinical, imaging and medication data were gained from patient records. The largest axial diameter of the tumors was measured using MRI scans in T1 weighted imaging with gadolinium and the edema in T2 weighted imaging. Due to a similar biological behavior, acoustic neuroma (AN) and meningiomas were stratified together and compared with metastases.
Results: 388 patients were included, 61 (15.7%) developed a radiation necrosis. Median follow-up was 24 (6-62) months with a median onset of radiation necrosis at 8 (6-12) months. The most frequent tumors were metastases with 47.2%, followed by AN with 32.2 % and meningiomas with 13.4%. Metastases presented with a significantly smaller diameter (p=0.038) but significantly more edema (p=0.017). Metastases were treated with a significantly higher median dose of 20 (18-20) Gy compared to meningioma and AN with a median dose of 14 (12-16) Gy (p<0.001). Compared to AN and meningiomas, metastases showed a significantly lower risk of radiation necrosis (p=0.002). However, a clear correlation between a higher dose and radiation necrosis (OR 1.745) could also be shown for all tumor entities (p<0.001), which should outweigh the lower risk of metastases per se. Age plays a significant role for radiation necrosis with an OR of 1.066 only in metastases (p=0.049). For non-malignant tumors, no significance with regard to age could be determined.
Neither surrounding edema nor the amount of cortisone given had an effect on the occurrence of radiation necrosis.
Conclusion: Although metastases demonstrated a significant lower risk of radiation necrosis, which may be explained by their smaller diameter, the higher dose for single stage radiosurgery of metastases may outweigh this benefit. For the first time, age has been shown as a risk factor for radiation necrosis in metastases.
