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Journal of Neurosurgical Sciences 2015 June;59(2):157-67

language: English

Post-stereotactic radiosurgery brain metastases: a review

Fabiano A. J. 1, 2, Qiu J. 3

1 Department of Neurosurgery, Roswell Park Cancer Institute, Buffalo, NY, USA;
2 Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA;
3 Department of Pathology, Roswell Park Cancer Institute, Buffalo, NY, USA


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Stereotactic radiosurgery (SR) is a standard therapy for brain metastases. Radiation necrosis (RN) of the brain is a syndrome of brain coagulative and fibrinoid necrosis and cortical irritation that occurs following radiotherapy. RN following SR peaks in a delayed fashion at 9-12 months postprocedure. Vasogenic cerebral edema secondary to necrosis occurs and can affect surrounding brain function. No definitive non-invasive diagnostic study exists to differentiate post-SR RN from recurrent metastatic tumor. Magnetic resonance (MR) imaging, MR spectroscopy, positron emission tomography, and perfusion-weighted MR imaging have been used to evaluate RN and are discussed. Treatment options for post-SR brain metastases include observation, corticosteroids, pentoxifylline and vitamin E, bevacizumab, radiotherapy, laser-interstitial thermal therapy, and surgical resection.

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Andrew.Fabiano@RoswellPark.org