Contributions of previous whole-brain radiation therapy, cumulative intracranial tumor volume, and repeat radiosurgery to adverse radiation effects following stereotactic radiosurgery for brain metastasis.

Ali A Alattar, Jiri Bartek, Alice Lin, Carlin Chuck, Hsien-Chung Chen, Giovanni Kozel, Sharona Ben-Haim, Clark C Chen

Abstract read

In one paragraph

Article in Clinical & experimental metastasis, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it

0cells of the map it votes in

0citing 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

0 citing papers in PubMed.

No citing paper in PubMed yet.

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

8 authors.

Ali A AlattarDepartment of Neurosurgery, Allegheny Health Network Neuroscience Institute, Pittsburgh, PA, USA.

Jiri BartekDepartment of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.

Alice LinDepartment of Neurosurgery, CNS Cancer, Legorreta Cancer Center, Warren Alpert School of Medicine, Rhode Island Hospital, Brown University, Providence, RI, USA.

Carlin ChuckDepartment of Neurosurgery, CNS Cancer, Legorreta Cancer Center, Warren Alpert School of Medicine, Rhode Island Hospital, Brown University, Providence, RI, USA.

Hsien-Chung ChenDepartment of Neurosurgery, CNS Cancer, Legorreta Cancer Center, Warren Alpert School of Medicine, Rhode Island Hospital, Brown University, Providence, RI, USA.

Giovanni KozelDepartment of Neurosurgery, CNS Cancer, Legorreta Cancer Center, Warren Alpert School of Medicine, Rhode Island Hospital, Brown University, Providence, RI, USA.

Sharona Ben-HaimDepartment of Neurosurgery, University of California San Diego, La Jolla, San Diego, CA, USA.

Clark C ChenDepartment of Neurosurgery, CNS Cancer, Legorreta Cancer Center, Warren Alpert School of Medicine, Rhode Island Hospital, Brown University, Providence, RI, USA. clark_chen@brown.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

FLAIR hyperintensity extending beyond a cerebral quadrant (FEQ+) after stereotactic radiosurgery (SRS) for brain metastases (BM) was a recently established imaging biomarker for steroid-dependent adverse radiation effects (ARE). In this study, we investigated the clinical and treatment‑related variables associated with the development of FEQ + ARE following SRS. Exploratory analyses were conducted in an initial cohort of 214 consecutively treated patients with 1,106 SRS‑treated brain metastases and subsequently validated in an independent cohort of 149 consecutively treated patients comprising 708 SRS‑treated lesions from a second institution. In the discovery cohort, 62 of 214 patients (29%) developed FEQ + ARE after SRS. On univariate analysis, the likelihood of FEQ + ARE increased with prior whole-brain radiation therapy (pWBRT; OR 4.97, p < 0.001), cumulative intracranial tumor volume (CITV; OR 1.02, p = 0.018), and the number of repeat SRS courses (OR 1.32, p = 0.049). These associations remained robust in multivariate modeling adjusted for follow-up duration. Variance analysis indicated that pWBRT accounted for the largest share of risk. These findings were confirmed in an independent cohort of 149 patients using a pre-specified multivariate model. In this validation cohort, 56 patients (38%) developed FEQ + ARE after SRS. The odds of FEQ + ARE were 22.2 (p = 0.006), 1.18 (p = 0.007), and 2.04 (p = 0.045) for pWBRT, CITV, and repeat SRS, respectively. Variance analysis again showed that pWBRT accounted for the largest share of FEQ + ARE risk. Across two institutional cohorts of consecutively treated patients with > 1,800 SRS-treated BM, prior WBRT, repeat radiosurgery, and higher cumulative intracranial tumor volume were consistently associated with the development FEQ + ARE.

Indexed as

Brain NeoplasmsCranial IrradiationRadiation InjuriesRadiosurgeryAdultAgedAged, 80 and overFemaleFollow-Up StudiesHumansMagnetic Resonance ImagingMaleMiddle AgedTumor BurdenAcute radiation effectsBrain metastasisStereotactic radiosurgery

Identifiers

PMID42658350

DOI10.1007/s10585-026-10423-z

What OpenQuestion holds

Textmetadata

Read underepoch 390

Registered trials

None linked

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.