Identification and Management of Progressive Enhancement After Radiation Therapy for Brain Metastases: Results from a Neurosurgical Survey.

Abstract:

OBJECTIVE:There is a lack of consensus regarding diagnosis, timing, and method of intervention for progressive enhancement on surveillance imaging after stereotactic radiosurgery (SRS) treatment of brain metastases. We sought to characterize current practices among neurosurgeons in identifying and treating infield tumor recurrence (TR) or radiation necrosis (RN) after SRS for brain metastases. METHODS:A voluntary survey was distributed electronically to preidentified neurosurgeons. Results were analyzed using descriptive statistics and χ2 analysis. RESULTS:A total of 120 participants completed the survey from 72 U.S. and 17 international centers. Most (69.2%) agreed that growth over ≥2 surveillance scans spaced ≥90 days apart identified irreversible progression after SRS for brain metastases. Respondents were evenly divided on the need for tissue biopsy to distinguish between TR and RN. Preferred treatment modality and time frame to initiate treatment of suspected RN differed among neurosurgeons based on SRS case volume for brain metastases (P = 0.002 and P = 0.02, respectively). Neurosurgeons who used magnetic resonance-guided laser interstitial thermal therapy (LITT) for brain metastases were more likely to prefer LITT for suspected RN, whereas those with minimal LITT experience preferred steroids (P < 0.0001). Neurosurgeons in the United States were more likely to prefer LITT for RN (37.3%) compared with international counterparts (0%). CONCLUSIONS:Our survey of practicing neurosurgeons highlights areas of controversy in distinguishing between TR and RN and preferred management of suspected RN.

journal_name

World Neurosurg

journal_title

World neurosurgery

authors

Semonche A,Patel NV,Yang I,Danish SF

doi

10.1016/j.wneu.2020.04.046

subject

Has Abstract

pub_date

2020-07-01 00:00:00

pages

e526-e540

eissn

1878-8750

issn

1878-8769

pii

S1878-8750(20)30753-1

journal_volume

139

pub_type

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