Extent of perilesional edema differentiates radionecrosis from tumor recurrence following stereotactic radiosurgery for brain metastases
Extent of perilesional edema differentiates radionecrosis from tumor recurrence following stereotactic radiosurgery for brain metastases
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DOI：
10.1093/neuonc/not130
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发表时间：
2013-12-01
期刊：
影响因子：
15.9
通讯作者：
Heron, Dwight E.
中科院分区：
文献类型：
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作者：
Leeman, Jonathan E.;Clump, David A.;Heron, Dwight E.
区分肿瘤复发和放射性坏死是脑转移瘤立体定向放射外科（SRS）治疗患者随访管理的关键步骤。一种方法，可以可靠地区分肿瘤复发与放射性坏死，使用标准的MR序列将显着values.We分析了49例患者的记录52脑转移瘤SRS治疗，随后接受手术切除相同的病变。其中47个病变有术前MRI可供审查（90），包括T1增强后、T2和液体衰减反转恢复序列。SRS前和术前病变和水肿体积手动勾画轮廓，并使用放射治疗计划软件以盲法测量。神经病理学家分析样本中肿瘤和/或放射性坏死的存在，发现SRS和切除之间的较长时间（P 0.001）和较大的水肿/病变体积比（高T2/T1 c，P 0.002）预测放射性坏死，而不是肿瘤复发。采用水肿/病变体积比的截止值为10，我们能够预测肿瘤的存在，阳性预测值为92，当只观察在SRS后18个月接受切除术的患者时，阳性预测值增加到100。在随访成像中，具有高水肿/病变体积比的病变和SRS后进展的病变更可能包含放射性坏死。这些指标可能有助于指导临床决策的背景下，不断发展的病变后SRS脑转移，从而避免不必要的干预。
Differentiation of tumor recurrence from radionecrosis is a critical step in the follow-up management of patients treated with stereotactic radiosurgery (SRS) for brain metastases. A method that can reliably differentiate tumor recurrence from radiation necrosis using standard MR sequences would be of significant value.We analyzed the records of 49 patients with 52 brain metastases treated with SRS who subsequently underwent surgical resection of the same lesion. Forty-seven of the lesions had preoperative MRI available for review (90), including T1 postcontrast, T2, and fluid attenuated inversion recovery sequences. Pre-SRS and preoperative lesion and edema volumes were manually contoured and measured in a blinded fashion using radiation treatment planning software. A neuropathologist analyzed samples for the presence of tumor and/or radiation necrosis.Longer time between SRS and resection (P .001) and a larger edema/lesion volume ratio (high T2/T1c, P .002) were found to be predictive of radionecrosis as opposed to tumor recurrence. Using a cutoff value of 10 for the edema/lesion volume ratio, we were able to predict the presence of tumor with a positive predictive value of 92, which increased to 100 when looking only at patients who underwent resection 18 months following SRS.On follow-up imaging, lesions with a high edema/lesion volume ratio and lesions that progress later after SRS are more likely to contain radionecrosis. These indices may help guide clinical decision making in the context of evolving lesions after SRS for brain metastases and thereby avoid unnecessary interventions.