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How do you manage new brain mets in a patient with a history of RT necrosis after prior SRS?
Assuming no overlap with prior RT doses, would a history of necrosis cause you to hypofractionate rather than deliver single fraction SRS?
Answer from: Radiation Oncologist at Academic Institution
The short answer is “yes”. For brain mets over 2 cm in maximum diameter, we and others have found that 3-5 fraction stereotactic radiation therapy has produced equivalent or better local control and lower incidence of radionecrosis than single fraction stereotactic radiosurgery. It would...
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Answer from: Radiation Oncologist at Academic Institution
Necrosis can be symptomatic or asymptomatic; symptomatic necrosis can be controlled with steroids or require more aggressive interventions such as avastin, resection, or LITT. The factors that go into the risks of any of those circumstances include dose/volume exposure, location, and possibly system...