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Staged Stereotactic Radiosurgery Decreases Symptomatic Radionecrosis in Large Brain Metastasis
Neil Chevli1, Hui-Chuan Wang2, Prachi Dubey3
1Department of Radiation Oncology, University of Texas Medical Branch at Galveston, Galveston, TX, U.S.A.
Background:
Limited brain metastasis is treated definitively with stereotactic radiosurgery when surgical resection is not indicated. Although this has historically been performed in a single fraction, multi-fraction approaches such as fraction radiosurgery (FSRS) and staged radiosurgery (SSRS) have been recently examined as alternative approaches for larger lesions to permit better tumor control without increased toxicity.
Case Report:
We present the case of a patient who developed symptomatic radionecrosis in two brain metastasis, 2.3 cm and 2.1 cm in size, which were treated with 18 Gy in one fraction, but no radionecrosis in a 3.3 cm lesion treated in two fractions of 15 Gy nor in two punctate lesions that were treated in one fraction of 20 Gy. Although she did not respond to steroids, she responded to bevacizumab symptomatically and on neuroimaging.
Conclusion:
Congruent with other recent studies, our report suggests that large brain metastasis should be considered for FSRS/SSRS.
