ArticleJournal of neuro-oncology2021
The effect of surgery on radiation necrosis in irradiated brain metastases: extent of resection and long-term clinical and radiographic outcomes.
Article in Journal of neuro-oncology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 2 of them syntheses that pooled it.
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The trial behind it
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
28 citing papers in PubMed, 2 syntheses or guidelines pooled it, 35 citations in OpenAlex.
- Resection of brain radionecrosis after stereotactic radiosurgery or radiotherapy: a meta-analysis.Neurosurgical review · 2026Pooled it
- DEGRO practical guideline for central nervous system radiation necrosis part 2: treatment.Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al] · 2022Guideline
- Headache as a Sentinel Signal After Cranial Radiotherapy: A Symptom-Driven Approach to Pathophysiology and Management.Neurology international · 2026Review
- Descriptive Analysis of Surgically Resected Pure Radiation Necrosis After Radiation Therapy for Brain Metastasis: Clinical Features, MRI Findings, and Outcomes.Brain tumor research and treatment · 2026Article
- A Challenging Differential Diagnosis Between Brain Radionecrosis and Recurrent Metastatic Disease, with Temporary Clinical/Radiological Response to Bevacizumab and Later Imaging Suspicious for Oligoprogression.Life (Basel, Switzerland) · 2026Article
- Reassessing the Management of Treatment-Induced Brain Necrosis in Metastatic Patients: Advancing Surgical Alternatives to Steroid Therapy.Neurosurgery practice · 2025Review
- Radiation Necrosis in Neuro-Oncology: Diagnostic Complexity and Precision Radiotherapy Strategies.Cancers · 2025Review
- Management outcomes for biopsy-proven radiation necrosis in patients with brain metastases in the era of immune-checkpoint blockade.Journal of neuro-oncology · 2025Article
- FLAIR extending beyond a quadrant (FEQ) of the cerebrum as a qualitative imaging biomarker: a conceptual proposition and proof-of-principle.Clinical & experimental metastasis · 2025Article
- Prognostic value of MIB-1 index in meningioma: a retrospective cohort study to establish an optimal cutoff for recurrence and survival.Journal of neuro-oncology · 2025Article
- Development of a recursive partitioning analysis for prediction of radiation necrosis following single-fraction stereotactic radiosurgery for intact brain metastases.Journal of neuro-oncology · 2025Article
- Role of microsurgical tumor burden reduction in patients with breast cancer brain metastases considering molecular subtypes: a two-center volumetric survival analysis.Journal of neuro-oncology · 2024Article
- The dilemma of radiation necrosis from diagnosis to treatment in the management of brain metastases.Neuro-oncology · 2024Review
- Case report: intracranial lesions in a patient with anxiety and depression: tumor recurrence or radiation encephalopathy?Frontiers in oncology · 2024Article
- Pseudoprogression versus true progression in glioblastoma: what neurosurgeons need to know.Journal of neurosurgery · 2023Review
- Recognition and Management of the Long-term Effects of Cranial Radiation.Current treatment options in oncology · 2023Review
- Review
- Efficacy of immunotherapy for melanoma brain metastases in patients with concurrent corticosteroid exposure.CNS oncology · 2023Article
- Postradiosurgery cystic degeneration in brain metastases causing delayed and potentially severe sequelae: systematic review and illustrative cases.Journal of neurosurgery. Case lessons · 2023Article
- Management of patients with brain metastases from NSCLC without a genetic driver alteration: upfront radiotherapy or immunotherapy?Therapeutic advances in medical oncology · 2023Review
Corrections and comments
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Authors and funding
11 authors at 2 institutions in 1 country.
Funding
Abstract
objectiveRadiation therapy is a cornerstone of brain metastasis (BrM) management but carries the risk of radiation necrosis (RN), which can require resection for palliation or diagnosis. We sought to determine the relationship between extent of resection (EOR) of pathologically-confirmed RN and postoperative radiographic and symptomatic outcomes.
methodsA single-center retrospective review was performed at an NCI-designated Comprehensive Cancer Center to identify all surgically-resected, previously-irradiated necrotic BrM without admixed recurrent malignancy from 2003 to 2018. Clinical, pathologic and radiographic parameters were collected. Volumetric analysis determined EOR and longitudinally evaluated perilesional T2-FLAIR signal preoperatively, postoperatively, and at 3-, 6-, 12-, and 24-months postoperatively when available. Rates of time to 50% T2-FLAIR reduction was calculated using cumulative incidence in the competing risks setting with last follow-up and death as competing events. The Spearman method was used to calculate correlation coefficients, and continuous variables for T2-FLAIR signal change, including EOR, were compared across groups.
resultsForty-six patients were included. Most underwent prior stereotactic radiosurgery with or without whole-brain irradiation (N = 42, 91%). Twenty-seven operations resulted in gross-total resection (59%; GTR). For the full cohort, T2-FLAIR edema decreased by a mean of 78% by 6 months postoperatively that was durable to last follow-up (p < 0.05). EOR correlated with edema reduction at last follow-up, with significantly greater T2-FLAIR reduction with GTR versus subtotal resection (p < 0.05). Among surviving patients, a significant proportion were able to decrease their steroid use: steroid-dependency decreased from 54% preoperatively to 15% at 12 months postoperatively (p = 0.001).
conclusionsRN resection conferred both durable T2-FLAIR reduction, which correlated with EOR; and reduced steroid dependency.
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Registered trials
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