Article
Delayed complications after stereotactic radiosurgery for brain metastases – neuro-imaging findings and treatments
Komplikationen nach stereotaktischer Radiochirurgie bei zerebralen Metastasen – Befunde und Behandlungen
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Published: | June 26, 2020 |
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Objective: Stereotactic radiosurgery (SRS) has been widely applied to the management of brain metastasis (BM) patients. We have already presented our incidences of and factors correlating with post-SRS complications and this paper was published in Radiotherapy and oncology in October 2018. We will present these results focusing on neuro-imaging findings and treatments.
Methods: This was an institutional review board-approved, retrospective cohort study using our prospectively accumulated database including 3519 patients (2100 males, 1419 females, mean age; 65 [range; 19-96] years) who underwent gamma knife SRS for BMs during the 1998-2018 period. The most common original tumor site was the lung (2300) followed by the gastro-intestinal tract (392), breast (399), kidney (139) and others (289). Median and mean tumor numbers were 3 and 7 (maximum; 89, IQR; 1-8). Median cumulative tumor volume was 5.4 (range; 0.01-126.2, IQR; 1.8-12.8) cc and median volume of the largest tumor was 3.6 (range; 0.01-94.2, IQR; 1.0-8.9) cc. The median maximum dose was 35 (range; 15-60, IQR; 30-40) Gy.
Results: The overall median survival time after SRS was 8.3 (95% CI; 8.0-8.8) months. Post-SRS complications occurred in 105 patients (3.0%) 0.5-135.6 (median; 13.9, IQR; 5.8-30.0) months after treatment. Cumulative incidences determined with a competing risk analysis were 0.8%, 1.7%, 2.4%, 2.6% and 2.8% at the 12th, 24th, 36th, 48th and 60th post-SRS month, respectively. Radiation necrosis was most commonly seen (77.9%) and was treated by steroid administration. The second finding was delayed cyst formation (11.6%) with/without a growing enhanced mass lesion which were treated by surgical intervention.
Conclusion: The post-SRS complication incidence is considered to be acceptably low (3.0%). Most complications could be managed by steroid treatment. However, cyst formation should be carefully followed up and surgical intervention should be for this condition, by which good treatment outcome could be expected.