Cyclooxygenase-2 inhibition to treat radiation-induced brain necrosis and edema

Brain necrosis and edema develop in a proportion of brain tumor patients treated with radiosurgery. Surgical resection and corticosteroids have considerable morbidity. Two metastatic melanoma brain lesions in a 14-year-old girl were treated with radiosurgery and whole-brain radiation treatment. Both lesions became symptomatic from radiologic features of necrosis and edema and were unresponsive to oral corticosteroids. The larger lesion was resected, but the other lesion continued to enlarge. Cyclooxygenase-2 (COX-2) inhibitor was started, and the child improved clinically and radiologically. The usefulness of COX-2 inhibitors in treating radiation necrosis and edema, as suggested by this report, requires further study.