PT  - JOURNAL ARTICLE
AU  - NEIL CHEVLI
AU  - HUI-CHUAN WANG
AU  - PRACHI DUBEY
AU  - WAQAR HAQUE
AU  - ANDREW M. FARACH
AU  - RAMIRO PINO
AU  - ROBERT C. ROSTOMILY
AU  - E. BRIAN BUTLER
AU  - BIN S. TEH
TI  - Staged Stereotactic Radiosurgery Decreases Symptomatic Radionecrosis in Large Brain Metastasis
AID  - 10.21873/anticanres.14902
DP  - 2021 Mar 01
TA  - Anticancer Research
PG  - 1445--1449
VI  - 41
IP  - 3
4099  - http://ar.iiarjournals.org/content/41/3/1445.short
4100  - http://ar.iiarjournals.org/content/41/3/1445.full
SO  - Anticancer Res2021 Mar 01; 41
AB  - Background: Limited brain metastasis is treated definitively with stereotactic radiosurgery when surgical resection is not indicated. Although this has historically been performed in a single fraction, multi-fraction approaches such as fraction radiosurgery (FSRS) and staged radiosurgery (SSRS) have been recently examined as alternative approaches for larger lesions to permit better tumor control without increased toxicity. Case Report: We present the case of a patient who developed symptomatic radionecrosis in two brain metastasis, 2.3 cm and 2.1 cm in size, which were treated with 18 Gy in one fraction, but no radionecrosis in a 3.3 cm lesion treated in two fractions of 15 Gy nor in two punctate lesions that were treated in one fraction of 20 Gy. Although she did not respond to steroids, she responded to bevacizumab symptomatically and on neuroimaging. Conclusion: Congruent with other recent studies, our report suggests that large brain metastasis should be considered for FSRS/SSRS.