Identification and Management of Progressive Enhancement after Radiation Therapy for Brain Metastases: Results from a Neurosurgical Survey.
World Neurosurg. 2020 Apr 17;:
Authors: Semonche A, Patel N, Yang I, Danish S
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. MethodsVoluntary survey distributed electronically to pre-identified neurosurgeons. Results were analyzed using descriptive statistics and chi-square analysis. Results120 participants completed the survey from 72 United States and 17 international centers. The majority (69.2%) agreed that growth over at least 2 surveillance scans spaced at least 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 timeframe to initiate treatment of suspected RN differed among neurosurgeons based on SRS case volume for brain metastases (P=.002 and P=.02, respectively). Neurosurgeons who utilized 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 to international counterparts (0%).
CONCLUSION: Our survey of practicing neurosurgeons highlights areas of controversy in distinguishing between TR and RN and preferred management of suspected RN.
PMID: 32311550 [PubMed – as supplied by publisher]