Evidence map›Paper›PMID 39543051›Full record

ArticleJournal of neuro-oncology2025

Association between tumor location and toxicity outcomes after stereotactic radiosurgery for brain metastases.

Boya Wang, Alexandra Bukowski, Orit Kaidar-Person, James M Choi, Deanna M Sasaki-Adams, Sivakumar Jaikumar, Dominique M Higgins, Matthew G Ewend, Soma Sengupta, Timothy M Zagar and 4 more

Abstract read
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In one paragraph

Article in Journal of neuro-oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Boya WangUniversity of North Carolina School of Medicine, Chapel Hill, NC, USA.
Alexandra BukowskiUniversity of North Carolina School of Medicine, Chapel Hill, NC, USA.
Orit Kaidar-PersonSheba Medical Center, Ramat Gan, Israel.
James M ChoiUniversity of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
Deanna M Sasaki-AdamsDepartment of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Sivakumar JaikumarDepartment of Neurosurgery, University of North Carolina REX Hospital, Raleigh, NC, USA.
Dominique M HigginsDepartment of Neurosurgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
Matthew G EwendDepartment of Neurosurgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
Soma SenguptaDepartment of Neurosurgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
Timothy M ZagarAlbany Med Health System, Albany, NY, USA.
Theodore K YanagiharaDepartment of Radiation Oncology, University of North Carolina School of Medicine, 101 Manning Drive, CB7512, Chapel Hill, NC, 27514, USA.
Joel E TepperDepartment of Radiation Oncology, University of North Carolina School of Medicine, 101 Manning Drive, CB7512, Chapel Hill, NC, 27514, USA.
Lawrence B MarksDepartment of Radiation Oncology, University of North Carolina School of Medicine, 101 Manning Drive, CB7512, Chapel Hill, NC, 27514, USA.
Colette J ShenDepartment of Radiation Oncology, University of North Carolina School of Medicine, 101 Manning Drive, CB7512, Chapel Hill, NC, 27514, USA. colette_shen@med.unc.edu.

Funding

NIH HHS P30-CA016086
6 · The paper itself

Abstract

purposeToxicities associated with stereotactic radiosurgery (SRS) are important when considering treatment and supportive management for patients with brain metastases. We herein assessed the association between brain metastasis location and risk of toxicity after SRS.

methodsWe conducted a retrospective institutional review of patients treated with SRS for brain metastases between 2008 and 2023. Outcomes included radiation necrosis, seizure, local failure, and overall survival (OS).

resultsWe reviewed 215 patients treated to 605 metastases (median diameter 10 mm, IQR 5-17 mm), in the frontal (34%), cerebellar (19%), parietal (16%), temporal (13%), and occipital (13%) regions. Median follow-up was 16 months (IQR 7-36). New-onset seizures developed in 11% (19/174) of patients without prior seizure and was higher in patients with motor or sensory cortex lesions (12/48, 25%) on multivariate analysis (MVA, P = 0.02). SRS-related grade ≥ 2 symptomatic radionecrosis occurred in 6% (33/605) of lesions and correlated with larger metastasis volume (P < 0.001) and renal cell carcinoma histology (P < 0.05), while supratentorial location was nearly significant (MVA, P = 0.06). Median OS across all patients was 16 months (95% CI 12-20). Patients with symptomatic radiation necrosis had a longer median survival compared to those who did not (43 vs. 14 months, P = 0.002), which remained significant alongside Karnofsky performance status and extracranial disease on MVA.

conclusionBrain metastasis location in the motor or sensory cortex is associated with increased risk of new-onset seizure following SRS and may warrant consideration of steroid and/or anti-epileptic prophylaxis. Symptomatic radiation necrosis is uncommon in the cerebellum and may be increasing with improvements in survival.

Indexed as

Brain NeoplasmsRadiosurgeryAdultAgedFemaleFollow-Up StudiesHumansMaleMiddle AgedRadiation InjuriesRetrospective StudiesSeizuresTreatment OutcomeBrain metastasisRadiation necrosisSeizureStereotactic radiosurgery

Identifiers

PMID39543051

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