J Neurosurg 142:1117–1124, 2025
This study investigates late radiation necrosis (LRN) occurring over 5 years post-stereotactic radiosurgery (SRS). It identifies risk factors, management strategies, and emphasizes the need for long-term follow-up, particularly for patients with a brain V12 Gy > 5 cm³ or history of early RN.
• Late Radiation Necrosis (LRN): LRN is a late complication occurring more than 5 years after stereotactic radiosurgery (SRS) and is associated with new neurological symptoms and specific imaging changes without disease recurrence.
• Study Objective: This study analyzes the incidence and risk factors for LRN occurring more than 5 years after SRS, highlighting that LRN risk persists beyond 5 years.
• Risk Factors: Significant risk factors for LRN include a brain V12 Gy > 5 cm³ and a history of early RN. Higher prescription doses and treatment to multiple lesions also increase LRN risk.
• Incidence and Management: LRN occurred in 8.7% of patients and 7.7% of lesions, with a median onset of 6.1 years post-SRS. Management included steroids, bevacizumab, and surgical resection when necessary.
• Imaging Features: LRN lesions showed T2/FLAIR hyperintensity, cystic changes, and T1-weighted postcontrast enhancement.
• Pathophysiology: LRN shares a similar pathophysiology with early RN, but with distinct features like cystic changes.
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