Surgery of enlarging lesions after stereotactic radiosurgery for brain metastases in patients with non-small cell lung cancer with oncogenic driver mutations frequently reveals radiation necrosis: case series and review
Fang Zhou
Departments of Radiotherapy, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
These authors contributed equally to this work.
Search for more papers by this authorLeilei Jiang
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Peking University, Beijing, China
These authors contributed equally to this work.
Search for more papers by this authorXuankai Sun
Departments of Radiotherapy, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
These authors contributed equally to this work.
Search for more papers by this authorZhen Wang
Departments of Radiotherapy, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
These authors contributed equally to this work.
Search for more papers by this authorJialin Feng
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Peking University, Beijing, China
Search for more papers by this authorCorresponding Author
Ming Liu
Departments of Radiotherapy, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
Zhao Ma and Ming Liu, Departments of Radiotherapy, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China. e-mail: [email protected]; [email protected]
Search for more papers by this authorCorresponding Author
Zhao Ma
Departments of Radiotherapy, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
Zhao Ma and Ming Liu, Departments of Radiotherapy, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China. e-mail: [email protected]; [email protected]
Search for more papers by this authorFang Zhou
Departments of Radiotherapy, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
These authors contributed equally to this work.
Search for more papers by this authorLeilei Jiang
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Peking University, Beijing, China
These authors contributed equally to this work.
Search for more papers by this authorXuankai Sun
Departments of Radiotherapy, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
These authors contributed equally to this work.
Search for more papers by this authorZhen Wang
Departments of Radiotherapy, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
These authors contributed equally to this work.
Search for more papers by this authorJialin Feng
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Peking University, Beijing, China
Search for more papers by this authorCorresponding Author
Ming Liu
Departments of Radiotherapy, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
Zhao Ma and Ming Liu, Departments of Radiotherapy, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China. e-mail: [email protected]; [email protected]
Search for more papers by this authorCorresponding Author
Zhao Ma
Departments of Radiotherapy, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
Zhao Ma and Ming Liu, Departments of Radiotherapy, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China. e-mail: [email protected]; [email protected]
Search for more papers by this authorAbstract
In brain metastases, radiation necrosis (RN) is a complication that arises after single or multiple fractionated stereotactic radiosurgery (SRS/FSRS), which is challenging to distinguish from local recurrence (LR). Studies have shown increased RN incidence rates in non-small cell lung cancer (NSCLC) patients with oncogenic driver mutations (ODMs) or receiving tyrosine kinase inhibitors (TKIs). This study investigated enlarging brain lesions following SRS/FSRS, for which additional surgeries were performed to distinguish between RN and LR. We investigated seven NSCLC patients with ODMs undergoing SRS/FSRS for BM and undergoing surgery for suspicion of LR on MRI imaging. Descriptive statistics were performed. Among the seven patients, six were EGFR+, while one was ALK+. The median irradiation dose was 30 Gy (range, 20–35 Gy). The median time to develop RN after SRS/FSRS was 11.1 months (range: 6.3–31.2 months). Moreover, gradually enlarging lesions were found in all patients after 6 months post-SRS/FSR. Brain radiation necrosis was pathologically confirmed in all the patients. RN should be suspected in NSCLC patients when lesions keep enlarging after 6 months post-SRS/FSRS, especially for patients with ODMs and receiving TKIs. Further, this case series indicates that further dose reduction might be necessary to avoid RN for such patients.
CONFLICT OF INTEREST
All authors have no conflicts of interest to declare.
Open Research
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available from the corresponding author upon reasonable request.
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