Evidence map›Paper›PMID 41200532›Full record

ReviewNeurosurgery practice2025

Reassessing the Management of Treatment-Induced Brain Necrosis in Metastatic Patients: Advancing Surgical Alternatives to Steroid Therapy.

Joshua D Bernstock, Nicholas B Dadario, Pablo A Valdés, Jakob V E Gerstl, Benjamin R Johnston, Lennard Spanehl, Florian A Gessler, Pierpaolo Peruzzi, Timothy R Smith, Gregory K Friedman and 4 more

Abstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Neurosurgery practice, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing 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

1 citing paper in PubMed.

  1. Review
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.

Joshua D BernstockDepartment of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.ORCID https://orcid.org/0000-0002-7814-3867
Nicholas B DadarioDepartment of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Pablo A ValdésDepartment of Neurosurgery, University of Texas Medical Branch, Webster, Texas, USA.
Jakob V E GerstlDepartment of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.ORCID https://orcid.org/0000-0002-8100-0517
Benjamin R JohnstonDepartment of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Lennard SpanehlDepartment of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Florian A GesslerDepartment of Neurosurgery, University Medicine Rostock, Rostock, Germany.
Pierpaolo PeruzziDepartment of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Timothy R SmithDepartment of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Gregory K FriedmanDivision of Pediatrics, Neuro-Oncology Section, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Wenya Linda BiDepartment of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
E A ChioccaDepartment of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Ayal AizerDepartment of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA.
Omar ArnaoutDepartment of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

The emergence of modern adjuvant therapies has significantly improved outcomes for patients with brain metastases. However, treatment-related side effects present an ongoing challenge, particularly, treatment-induced necrosis characterized by perilesional edema and inflammation. Standard management with steroids compromises the efficacy of otherwise efficacious immunotherapeutic approaches. This position paper critiques traditional management strategies that rely heavily on systemic corticosteroid therapy-often ineffective in providing lasting relief and associated with serious side effects-and proposes a paradigm shift that prioritizes surgical resection. Resection facilitates prompt edema reduction with a low recurrence rate of symptoms and mitigates the adverse effects of prolonged corticosteroid use. We propose increased consideration for resecting symptomatic radiation necrosis to facilitate improved efficacy of immunotherapies in patients with brain metastases.

Indexed as

Brain metastasisMetastasisNeurosurgeryTreatment necrosis

Identifiers

PMID41200532
PMCPMC12588697

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.