A Systematic Review Informing The Management of Symptomatic Brain Radiation Necrosis after Stereotactic Radiosurgery and International Stereotactic Radiosurgery Society (ISRS) Recommendations
Abstract
BACKGROUND
Radiation necrosis (RN) secondary to stereotactic radiosurgery is a significant cause of morbidity. The optimal management of corticosteroid-refractory brain RN remains unclear.
OBJECTIVE
To summarise the literature specific to efficacy and toxicity of treatment paradigms for patients with symptomatic corticosteroid refractory RN. To provide consensus guidelines for grading and management of RN on behalf of the International Stereotactic Radiosurgery Society (ISRS).
METHODS
A systematic review of articles pertaining to treatment of RN with bevacizumab, laser interstitial thermal therapy (LITT), surgical resection, or hyperbaric oxygen therapy (HBOT) was performed. The primary composite outcome was clinical and/or radiological stability/ improvement (i.e., proportion of patients achieving improvement or stability with the given intervention). Proportions of patients achieving the primary outcome were pooled using random weighted-effects analysis, but not directly compared between interventions.
RESULTS
Twenty-one articles were included, of which only two were prospective studies. Thirteen reports were relevant for bevacizumab, 5 for LITT, 5 for surgical resection and 1 for HBOT. Weighted effects analysis revealed that bevacizumab had a pooled symptom improvement/stability rate of 86% (95% CI: 77-92%), pooled T2 imaging improvement/stability rate of 93% (95% CI: 87 -98%), and pooled T1-post contrast improvement/stability rate of 94% (95% CI: 87 - 98%). Subgroup…
How strong is the evidence?
Evidence Hub reads this as a systematic review. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
Read the paper
Related studies
- Preliminary Toxicity Analysis of 3DCRT versus IMRT on the High Dose Arm of the RTOG 0126 Prostate Cancer Trial
- Adaptive Radiotherapy for Head and Neck Cancer: Initial Clinical Outcomes from a Prospective Trial
- American Association of Physicists in Medicine Task Group 263: Standardizing Nomenclatures in Radiation Oncology
- Motion Management Strategies and Technical Issues Associated with Stereotactic Body Radiotherapy of Thoracic and Upper Abdominal Tumors: A Review from NRG Oncology
- High-dose-rate interstitial brachytherapy as a monotherapy for localized prostate cancer: treatment description and preliminary results of a phase I/II clinical trial
- Highly efficient training, refinement, and validation of a knowledge-based plan quality control system for radiotherapy clinical trials
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.