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Shah AH, Mahavadi AK, Morell A, et al. Salvage craniotomy for treatment-refractory symptomatic cerebral radiation necrosis. Neurooncol Pract. 2019;7(1):94-102doi: 10.1093/nop/npz028.
Shah, A. H., Mahavadi, A. K., Morell, A., Eichberg, D. G., Luther, E., Sarkiss, C. A., Semonche, A., Ivan, M. E., & Komotar, R. J. (2020). Salvage craniotomy for treatment-refractory symptomatic cerebral radiation necrosis. Neuro-oncology practice, 7(1), 94-102. https://doi.org/10.1093/nop/npz028
Shah, Ashish H, et al. "Salvage craniotomy for treatment-refractory symptomatic cerebral radiation necrosis." Neuro-oncology practice vol. 7,1 (2020): 94-102. doi: https://doi.org/10.1093/nop/npz028
Shah AH, Mahavadi AK, Morell A, Eichberg DG, Luther E, Sarkiss CA, Semonche A, Ivan ME, Komotar RJ. Salvage craniotomy for treatment-refractory symptomatic cerebral radiation necrosis. Neurooncol Pract. 2020 Jan;7(1):94-102. doi: 10.1093/nop/npz028. Epub 2019 Jul 03. PMID: 32257288; PMCID: PMC7104877.
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Neurooncol Pract. 2020 Jan;7(1):94-102. doi: 10.1093/nop/npz028. Epub 2019 Jul 03.

Salvage craniotomy for treatment-refractory symptomatic cerebral radiation necrosis.

Neuro-oncology practice

Ashish H Shah, Anil K Mahavadi, Alexis Morell, Daniel G Eichberg, Evan Luther, Christopher A Sarkiss, Alexa Semonche, Michael E Ivan, Ricardo J Komotar

Affiliations

  1. Department of Neurosurgery, University of Miami, FL, USA.

PMID: 32257288 PMCID: PMC7104877 DOI: 10.1093/nop/npz028

Abstract

BACKGROUND: The incidence of symptomatic radiation necrosis (RN) has risen as radiotherapy is increasingly used to control brain tumor progression. Traditionally managed with steroids, symptomatic RN can remain refractory to medical treatment, requiring surgical intervention for control. The purpose of our study was to assess a single institution's experience with craniotomy for steroid-refractory pure RN.

METHODS: The medical records of all tumor patients who underwent craniotomies at our institution from 2011 to 2016 were retrospectively reviewed for a history of preoperative radiotherapy or radiosurgery. RN was confirmed histopathologically and patients with active tumor were excluded. Preoperative, intraoperative, and outcome information was collected. Primary outcomes measured were postoperative KPS and time to steroid freedom.

RESULTS: Twenty-four patients with symptomatic RN were identified. Gross total resection was achieved for all patients. Patients with metastases experienced an increase in KPS (80 vs 100,

CONCLUSION: In cases of treatment-refractory symptomatic RN, resection can lead to an overall improvement in postoperative health status and neurological outcomes with minimal RN recurrence. Craniotomy for surgically accessible RN can safely manage symptomatic patients, and future studies assessing the efficacy of resection vs bevacizumab may be warranted.

© The Author(s) 2019. Published by Oxford University Press on behalf of the Society for Neuro-Oncology and the European Association of Neuro-Oncology. All rights reserved. For permissions, please e-mail: [email protected].

Keywords: metastatic brain tumor; outcomes; primary brain tumor; radiation necrosis; salvage craniotomy

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