SynthesisEuropean radiology2021
Immune checkpoint inhibitor therapy may increase the incidence of treatment-related necrosis after stereotactic radiosurgery for brain metastases: a systematic review and meta-analysis.
Synthesis in European radiology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 3 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
24 citing papers in PubMed, 3 syntheses or guidelines pooled it, 39 citations in OpenAlex.
- DEGRO practical guideline for central nervous system radiation necrosis part 2: treatment.Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al] · 2022Guideline
- [Efficacy and Safety of Radiotherapy Combined with Immunotherapy for Brain Metastases from Lung Cancer: A Meta-analysis].Zhongguo fei ai za zhi = Chinese journal of lung cancer · 2022Pooled it
- DEGRO practical guideline for central nervous system radiation necrosis part 1: classification and a multistep approach for diagnosis.Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al] · 2022Guideline
- Consolidative stereotactic radiotherapy for oligo-residual non-small cell lung cancer after first-line chemoimmunotherapy: A single-arm, phase 2 trial from China.PLoS medicine · 2025Trial
- Dose selection and clinical decision-making after Gamma Knife surgery for large brain metastases: implications for early identification of true progression.Journal of neuro-oncology · 2026Observational
- Survival outcomes and molecular predictors in small cell lung cancer with brain metastases receiving immunotherapy.Journal of neuro-oncology · 2026Article
- Anlotinib combined with temozolomide for brain metastases in small cell lung cancer with early recurrence after whole-brain radiotherapy: a case report.Frontiers in medicine · 2026Article
- Combined stereotactic radiotherapy and immunotherapy improves survival in driver-gene-negative NSCLC patients with brain oligo-metastases: a multicenter real-world study.Journal of neuro-oncology · 2025Article
- Tailored radiotherapy for brain metastases improves precision and outcomes.Discover oncology · 2025Review
- Immunotherapy may promote the occurrence of radiation-induced brain injury in NSCLC patients with brain metastases undergoing radiotherapy: a retrospective propensity score-matching and inverse probability of treatment weighting study.Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico · 2025Article
- Impact of brain metastasis size at the time of radiotherapy on local control and radiation necrosis.Journal of neuro-oncology · 2025Article
- Local recurrence and radionecrosis after single-isocenter multiple targets stereotactic radiotherapy for brain metastases.Scientific reports · 2025Article
- Research trends on stereotactic radiosurgery in brain metastases: a bibliometric analysis from 2013 to 2023.Quantitative imaging in medicine and surgery · 2025Article
- Review
- Response of treatment-naive brain metastases to stereotactic radiosurgery.Nature communications · 2024Article
- PD-L1 inhibitors combined with whole brain radiotherapy in patients with small cell lung cancer brain metastases: Real-world evidence.Cancer medicine · 2024Article
- Article
- Review
- Neurotoxicity from Old and New Radiation Treatments for Brain Tumors.International journal of molecular sciences · 2023Review
- Efficacy of different therapies for brain metastases of non-small cell lung cancer: a systematic review and meta-analysis.Translational lung cancer research · 2023Article
Corrections and comments
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Authors and funding
9 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo compare the incidence of treatment-related necrosis between combination SRS+ICI therapy and SRS therapy alone in patients with brain metastases from melanoma and non-small cell lung cancer (NSCLC).
methodsA systematic literature search of Ovid-MEDLINE and EMBASE was performed up to August 10, 2020. The difference in the pooled incidence of treatment-related necrosis after SRS+ICI or SRS alone was evaluated. The cumulative incidence of treatment-related necrosis at the specific time point after the treatment was calculated and plotted. Subgroup and meta-regression analyses were additionally performed.
resultsSixteen studies (14 on melanoma, 2 on NSCLC) were included. In NSCLC brain metastasis, the reported incidences of treatment-related necrosis in SRS+ICI and SRS alone ranged 2.9-3.4% and 0-2.9%, respectively. Meta-analysis was conducted including 14 studies on melanoma brain metastasis. The incidence of treatment-related necrosis was higher in SRS+ICI than SRS alone (16.0% vs. 6.5%; p = 0.065; OR, 2.35). The incidence showed rapid increase until 12 months after the SRS when combined with ICI therapy (14%; 95% CI, 8-22%) and its pace of increase slowed thereafter. Histopathologic diagnosis as the reference standard for treatment-related necrosis and inclusion of only symptomatic cases were the source of heterogeneity in SRS+ICI.
conclusionsTreatment-related necrosis tended to occur 2.4 times more frequently in the setting of combination SRS+ICI therapy compared with SRS alone in melanoma brain metastasis showing high cumulative incidence within the first year. Treatment-related necrosis should be considered when SRS+ICI combination therapy is used for melanoma brain metastasis, especially in the first year. KEY POINTS: • Treatment-related necrosis occurred 2.4 times more frequently in the setting of combination SRS+ICI therapy compared with SRS alone in melanoma brain metastasis. • Treatment-related necrosis more frequently occurred in brain metastases from melanoma than NSCLC. • Reference standard for treatment-related necrosis and inclusion of only symptomatic treatment-related necrosis were a significant source of heterogeneity, indicating varying definitions of treatment-related necrosis in the literature need to be unified.
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