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Case report
peer-reviewed

Radiation Necrosis – A Growing Problem in a Case of Brain Metastases Following Whole Brain Radiotherapy and Stereotactic Radiosurgery



Abstract

Stereotactic radiosurgery (SRS) provides excellent control in the treatment of brain metastases (BM). The use of newer, targeted and immunotherapy treatments have resulted in improved overall survival in patients even with an extensive metastatic disease. Hence, it is increasingly important to consider the potential for late toxicities like radiation-induced necrosis (RN) of the brain. We present a case of a patient with stage IV anaplastic lymphoma kinase (ALK) positive adenocarcinoma of the lung who underwent stereotactic radiosurgery to her brain metastases and received targeted treatment. While her intracranial and extracranial disease remained well controlled, we discuss the radiation-induced necrosis she suffered as a result of the treatment, the related diagnostic dilemma involved, and the subsequent management of this late toxicity of stereotactic radiosurgery.



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Case report
peer-reviewed

Radiation Necrosis – A Growing Problem in a Case of Brain Metastases Following Whole Brain Radiotherapy and Stereotactic Radiosurgery


Author Information

Yee Pei Song Corresponding Author

Clinical Oncology, ‎The Christie NHS Foundation Trust

Rovel J. Colaco

Radiation Oncology, ‎The Christie NHS Foundation Trust

Therapeutic Radiology, Yale University


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: Yee Pei Song declare(s) a grant from Bayer. Unconditional educational grant to attend ESTRO 36. Yee Pei Song declare(s) personal fees from Pfizer. Honorarium for presentation in November 2015. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.


Case report
peer-reviewed

Radiation Necrosis – A Growing Problem in a Case of Brain Metastases Following Whole Brain Radiotherapy and Stereotactic Radiosurgery


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Case report
peer-reviewed

Radiation Necrosis – A Growing Problem in a Case of Brain Metastases Following Whole Brain Radiotherapy and Stereotactic Radiosurgery

  • Author Information
    Yee Pei Song Corresponding Author

    Clinical Oncology, ‎The Christie NHS Foundation Trust

    Rovel J. Colaco

    Radiation Oncology, ‎The Christie NHS Foundation Trust

    Therapeutic Radiology, Yale University


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: Yee Pei Song declare(s) a grant from Bayer. Unconditional educational grant to attend ESTRO 36. Yee Pei Song declare(s) personal fees from Pfizer. Honorarium for presentation in November 2015. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements


    Article Information

    Published: January 08, 2018

    DOI

    10.7759/cureus.2037

    Cite this article as:

    Song Y, Colaco R J (January 08, 2018) Radiation Necrosis – A Growing Problem in a Case of Brain Metastases Following Whole Brain Radiotherapy and Stereotactic Radiosurgery. Cureus 10(1): e2037. doi:10.7759/cureus.2037

    Publication history

    Received by Cureus: November 27, 2017
    Peer review began: November 30, 2017
    Peer review concluded: January 03, 2018
    Published: January 08, 2018

    Copyright

    © Copyright 2018
    Song et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Stereotactic radiosurgery (SRS) provides excellent control in the treatment of brain metastases (BM). The use of newer, targeted and immunotherapy treatments have resulted in improved overall survival in patients even with an extensive metastatic disease. Hence, it is increasingly important to consider the potential for late toxicities like radiation-induced necrosis (RN) of the brain. We present a case of a patient with stage IV anaplastic lymphoma kinase (ALK) positive adenocarcinoma of the lung who underwent stereotactic radiosurgery to her brain metastases and received targeted treatment. While her intracranial and extracranial disease remained well controlled, we discuss the radiation-induced necrosis she suffered as a result of the treatment, the related diagnostic dilemma involved, and the subsequent management of this late toxicity of stereotactic radiosurgery.



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Yee Pei Song, MRCP, FRCR

Clinical Oncology, ‎The Christie NHS Foundation Trust

For correspondence:
yeepei.song@christie.nhs.uk

Rovel J. Colaco

Radiation Oncology, ‎The Christie NHS Foundation Trust

Yee Pei Song, MRCP, FRCR

Clinical Oncology, ‎The Christie NHS Foundation Trust

For correspondence:
yeepei.song@christie.nhs.uk

Rovel J. Colaco

Radiation Oncology, ‎The Christie NHS Foundation Trust