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Stereotactic Radiosurgery for Gynecologic Cancer
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Radiation Necrosis from Stereotactic Radiosurgery-How Do We Mitigate?

Balamurugan A Vellayappan1, Tresa McGranahan2,3, Jerome Graber2,3

  • 1Department of Radiation oncology, National University Cancer Institute, 1E Kent Ridge Road, Level 7 Tower block, Singapore, 119228, Singapore. Bala_vellayappan@nuhs.edu.sg.

Current Treatment Options in Oncology
|June 7, 2021
PubMed
Summary

Intracranial stereotactic radiosurgery (SRS) offers effective brain treatment. Careful patient selection and strategies like hypofractionated SRS (HSRT) are crucial to minimize radiation necrosis (RN) risks.

Keywords:
Brain metastasesHypofractionated stereotactic radiotherapyMitigation strategiesRadiation necrosisStereotactic radiosurgery

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Area of Science:

  • Neurosurgery
  • Radiation Oncology
  • Medical Physics

Background:

  • Intracranial stereotactic radiosurgery (SRS) is a widely used treatment for various brain conditions.
  • Current safety data primarily stems from retrospective studies, limiting comprehensive interpretation due to methodological variations.
  • Radiation necrosis (RN) is a significant concern, increasingly identified on follow-up imaging.

Purpose of the Study:

  • To review the safety and efficacy of intracranial SRS.
  • To highlight challenges in managing radiation necrosis (RN).
  • To discuss mitigation strategies for reducing RN risk in SRS patients.

Main Methods:

  • Review of existing literature, including retrospective and prospective studies.
  • Analysis of clinical focus on radiation necrosis (RN) and its management.
  • Evaluation of mitigation strategies such as dose reduction and hypofractionated stereotactic radiation therapy (HSRT).

Main Results:

  • Variations in SRS protocols complicate data interpretation.
  • Radiation necrosis (RN) management involves medical therapy or surgery for refractory cases.
  • Hypofractionated SRS (HSRT) shows promise for larger lesions without compromising efficacy.

Conclusions:

  • Optimal patient selection for SRS is critical for complication-free outcomes.
  • Mitigation strategies, including HSRT, are essential for high-risk scenarios.
  • A combined surgical and radiation approach may be considered for high-risk cases.