Association Between Radiation Necrosis and Tumor Biology After Stereotactic Radiosurgery for Brain Metastasis
Background The primary dose-limiting toxicity of stereotactic radiosurgery (SRS) is radiation necrosis (RN), which occurs after approximately 5% to 10% of treatments. This adverse event may worsen neurologic deficits, increase the frequency and cost of imaging, and necessitate prolonged treatment wi...
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| creator | Miller, Jacob A., BS Bennett, Elizabeth E., MD Xiao, Roy, BS Kotecha, Rupesh, MD Chao, Samuel T., MD Vogelbaum, Michael A., MD, PhD Barnett, Gene H., MD, MBA Angelov, Lilyana, MD Murphy, Erin S., MD Yu, Jennifer S., MD, PhD Ahluwalia, Manmeet S., MD Suh, John H., MD Mohammadi, Alireza M., MD |
| description | Background The primary dose-limiting toxicity of stereotactic radiosurgery (SRS) is radiation necrosis (RN), which occurs after approximately 5% to 10% of treatments. This adverse event may worsen neurologic deficits, increase the frequency and cost of imaging, and necessitate prolonged treatment with steroids or antiangiogenic agents. Previous investigations have primarily identified lesion size and dosimetric constraints as risk factors for RN in small populations. We hypothesized that disease histology, receptor status, and mutational status are associated with RN. Methods and Materials All patients presenting with brain metastasis between 1997 and 2015 who underwent SRS and subsequent radiographic follow-up at a single tertiary-care institution were eligible for inclusion. The primary outcome was the cumulative incidence of radiographic RN. Multivariate competing risks regression was used to identify biological risk factors for RN. Results 1939 patients (5747 lesions) were eligible for inclusion; 285 patients (15%) experienced radiographic RN after the treatment of 427 (7%) lesions. After SRS, the median time to RN was 7.6 months. After multivariate analysis, graded prognostic assessment, renal pathology, lesion diameter, and the heterogeneity index remained independently predictive of RN in the pooled cohort. In subset analyses of individual pathologies, HER2 -amplified status (hazard ratio [HR] 2.05, P =.02), BRAF V600+ mutational status (HR 0.33, P =.04), lung adenocarcinoma histology (HR 1.89, P =.04), and ALK rearrangement (HR 6.36, P |
| doi_str_mv | 10.1016/j.ijrobp.2016.08.039 |
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| fullrecord | <record><control><sourceid>elsevier_osti_</sourceid><recordid>TN_cdi_osti_scitechconnect_22645729</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0360301616331546</els_id><sourcerecordid>S0360301616331546</sourcerecordid><originalsourceid>FETCH-LOGICAL-c511t-3246701962112db274a701d05614a6472106589381c714703dba5ae3c9335fc73</originalsourceid><addsrcrecordid>eNqFkU1v1DAQhi0EokvhHyAUiXOCx5_JBWlblQ-ptBItEjfL60yKw268sr2g_fc4pPTQC5Jla-z3Hc88Q8hroA1QUO_Gxo8xbPYNK1FD24by7glZQau7mkv5_SlZUa5ozcvzCXmR0kgpBdDiOTlhWgsmBV2R3Tql4LzNPkzVGebfiFP11fb3N1foYkg-VXbqq9vDLsTqzIdtuDtW6yFjrG7KhiFbl7376wvpEO8wHqth1kbrp-oLZpvK8ukleTbYbcJX9-cp-fbh4vb8U315_fHz-fqydhIg15wJpSl0igGwfsO0sCXsqVQgrBKaAVWy7XgLToPQlPcbKy1y13EuB6f5KXm75A0pe5Ocz-h-uDBN6LJhTAmpWVdUYlHNPaaIg9lHv7PxaICambEZzcLYzIwNbU1hXGxvFtv-sNlh_2D6B7UI3i8CLC3-8hjnCnBy2Ps4F9AH_78fHidwWz95Z7c_8YhpDIc4FXwGTGKGmpt5zvOYQXEOUij-B5Rmo2Q</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Association Between Radiation Necrosis and Tumor Biology After Stereotactic Radiosurgery for Brain Metastasis</title><source>MEDLINE</source><source>Access via ScienceDirect (Elsevier)</source><creator>Miller, Jacob A., BS ; Bennett, Elizabeth E., MD ; Xiao, Roy, BS ; Kotecha, Rupesh, MD ; Chao, Samuel T., MD ; Vogelbaum, Michael A., MD, PhD ; Barnett, Gene H., MD, MBA ; Angelov, Lilyana, MD ; Murphy, Erin S., MD ; Yu, Jennifer S., MD, PhD ; Ahluwalia, Manmeet S., MD ; Suh, John H., MD ; Mohammadi, Alireza M., MD</creator><creatorcontrib>Miller, Jacob A., BS ; Bennett, Elizabeth E., MD ; Xiao, Roy, BS ; Kotecha, Rupesh, MD ; Chao, Samuel T., MD ; Vogelbaum, Michael A., MD, PhD ; Barnett, Gene H., MD, MBA ; Angelov, Lilyana, MD ; Murphy, Erin S., MD ; Yu, Jennifer S., MD, PhD ; Ahluwalia, Manmeet S., MD ; Suh, John H., MD ; Mohammadi, Alireza M., MD</creatorcontrib><description>Background The primary dose-limiting toxicity of stereotactic radiosurgery (SRS) is radiation necrosis (RN), which occurs after approximately 5% to 10% of treatments. This adverse event may worsen neurologic deficits, increase the frequency and cost of imaging, and necessitate prolonged treatment with steroids or antiangiogenic agents. Previous investigations have primarily identified lesion size and dosimetric constraints as risk factors for RN in small populations. We hypothesized that disease histology, receptor status, and mutational status are associated with RN. Methods and Materials All patients presenting with brain metastasis between 1997 and 2015 who underwent SRS and subsequent radiographic follow-up at a single tertiary-care institution were eligible for inclusion. The primary outcome was the cumulative incidence of radiographic RN. Multivariate competing risks regression was used to identify biological risk factors for RN. Results 1939 patients (5747 lesions) were eligible for inclusion; 285 patients (15%) experienced radiographic RN after the treatment of 427 (7%) lesions. After SRS, the median time to RN was 7.6 months. After multivariate analysis, graded prognostic assessment, renal pathology, lesion diameter, and the heterogeneity index remained independently predictive of RN in the pooled cohort. In subset analyses of individual pathologies, HER2 -amplified status (hazard ratio [HR] 2.05, P =.02), BRAF V600+ mutational status (HR 0.33, P =.04), lung adenocarcinoma histology (HR 1.89, P =.04), and ALK rearrangement (HR 6.36, P <.01) were also associated with RN. Conclusions In the present investigation constituting the largest series of RN, several novel risk factors were identified, including renal histology, lung adenocarcinoma histology, HER2 amplification, and ALK / BRAF mutational status. These risk factors may be used to guide clinical trial design incorporating biological risk stratification or dose escalation. Future studies determining the optimal timing of targeted therapies are warranted to further define the risk of RN.</description><identifier>ISSN: 0360-3016</identifier><identifier>EISSN: 1879-355X</identifier><identifier>DOI: 10.1016/j.ijrobp.2016.08.039</identifier><identifier>PMID: 27742540</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adenocarcinoma - pathology ; Adenocarcinoma - secondary ; BIOMEDICAL RADIOGRAPHY ; BRAIN ; Brain - pathology ; Brain - radiation effects ; Brain Neoplasms - chemistry ; Brain Neoplasms - genetics ; Brain Neoplasms - radiotherapy ; Brain Neoplasms - secondary ; Breast Neoplasms - genetics ; Carcinoma, Non-Small-Cell Lung - genetics ; Carcinoma, Squamous Cell - genetics ; CLINICAL TRIALS ; Female ; Gene Amplification ; Genes, erbB-2 ; Hematology, Oncology and Palliative Medicine ; HISTOLOGY ; Humans ; Lung Neoplasms - pathology ; Male ; Melanoma - genetics ; Middle Aged ; MULTIVARIATE ANALYSIS ; NECROSIS ; Necrosis - diagnostic imaging ; Necrosis - etiology ; Necrosis - genetics ; PATIENTS ; Proto-Oncogene Proteins B-raf ; Radiation Injuries - complications ; Radiation Injuries - diagnostic imaging ; Radiation Injuries - pathology ; Radiology ; RADIOLOGY AND NUCLEAR MEDICINE ; Radiosurgery - adverse effects ; RADIOTHERAPY ; Regression Analysis ; Retrospective Studies ; SURGERY</subject><ispartof>International journal of radiation oncology, biology, physics, 2016-12, Vol.96 (5), p.1060-1069</ispartof><rights>Elsevier Inc.</rights><rights>2016 Elsevier Inc.</rights><rights>Copyright © 2016 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c511t-3246701962112db274a701d05614a6472106589381c714703dba5ae3c9335fc73</citedby><cites>FETCH-LOGICAL-c511t-3246701962112db274a701d05614a6472106589381c714703dba5ae3c9335fc73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ijrobp.2016.08.039$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,780,784,885,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27742540$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://www.osti.gov/biblio/22645729$$D View this record in Osti.gov$$Hfree_for_read</backlink></links><search><creatorcontrib>Miller, Jacob A., BS</creatorcontrib><creatorcontrib>Bennett, Elizabeth E., MD</creatorcontrib><creatorcontrib>Xiao, Roy, BS</creatorcontrib><creatorcontrib>Kotecha, Rupesh, MD</creatorcontrib><creatorcontrib>Chao, Samuel T., MD</creatorcontrib><creatorcontrib>Vogelbaum, Michael A., MD, PhD</creatorcontrib><creatorcontrib>Barnett, Gene H., MD, MBA</creatorcontrib><creatorcontrib>Angelov, Lilyana, MD</creatorcontrib><creatorcontrib>Murphy, Erin S., MD</creatorcontrib><creatorcontrib>Yu, Jennifer S., MD, PhD</creatorcontrib><creatorcontrib>Ahluwalia, Manmeet S., MD</creatorcontrib><creatorcontrib>Suh, John H., MD</creatorcontrib><creatorcontrib>Mohammadi, Alireza M., MD</creatorcontrib><title>Association Between Radiation Necrosis and Tumor Biology After Stereotactic Radiosurgery for Brain Metastasis</title><title>International journal of radiation oncology, biology, physics</title><addtitle>Int J Radiat Oncol Biol Phys</addtitle><description>Background The primary dose-limiting toxicity of stereotactic radiosurgery (SRS) is radiation necrosis (RN), which occurs after approximately 5% to 10% of treatments. This adverse event may worsen neurologic deficits, increase the frequency and cost of imaging, and necessitate prolonged treatment with steroids or antiangiogenic agents. Previous investigations have primarily identified lesion size and dosimetric constraints as risk factors for RN in small populations. We hypothesized that disease histology, receptor status, and mutational status are associated with RN. Methods and Materials All patients presenting with brain metastasis between 1997 and 2015 who underwent SRS and subsequent radiographic follow-up at a single tertiary-care institution were eligible for inclusion. The primary outcome was the cumulative incidence of radiographic RN. Multivariate competing risks regression was used to identify biological risk factors for RN. Results 1939 patients (5747 lesions) were eligible for inclusion; 285 patients (15%) experienced radiographic RN after the treatment of 427 (7%) lesions. After SRS, the median time to RN was 7.6 months. After multivariate analysis, graded prognostic assessment, renal pathology, lesion diameter, and the heterogeneity index remained independently predictive of RN in the pooled cohort. In subset analyses of individual pathologies, HER2 -amplified status (hazard ratio [HR] 2.05, P =.02), BRAF V600+ mutational status (HR 0.33, P =.04), lung adenocarcinoma histology (HR 1.89, P =.04), and ALK rearrangement (HR 6.36, P <.01) were also associated with RN. Conclusions In the present investigation constituting the largest series of RN, several novel risk factors were identified, including renal histology, lung adenocarcinoma histology, HER2 amplification, and ALK / BRAF mutational status. These risk factors may be used to guide clinical trial design incorporating biological risk stratification or dose escalation. Future studies determining the optimal timing of targeted therapies are warranted to further define the risk of RN.</description><subject>Adenocarcinoma - pathology</subject><subject>Adenocarcinoma - secondary</subject><subject>BIOMEDICAL RADIOGRAPHY</subject><subject>BRAIN</subject><subject>Brain - pathology</subject><subject>Brain - radiation effects</subject><subject>Brain Neoplasms - chemistry</subject><subject>Brain Neoplasms - genetics</subject><subject>Brain Neoplasms - radiotherapy</subject><subject>Brain Neoplasms - secondary</subject><subject>Breast Neoplasms - genetics</subject><subject>Carcinoma, Non-Small-Cell Lung - genetics</subject><subject>Carcinoma, Squamous Cell - genetics</subject><subject>CLINICAL TRIALS</subject><subject>Female</subject><subject>Gene Amplification</subject><subject>Genes, erbB-2</subject><subject>Hematology, Oncology and Palliative Medicine</subject><subject>HISTOLOGY</subject><subject>Humans</subject><subject>Lung Neoplasms - pathology</subject><subject>Male</subject><subject>Melanoma - genetics</subject><subject>Middle Aged</subject><subject>MULTIVARIATE ANALYSIS</subject><subject>NECROSIS</subject><subject>Necrosis - diagnostic imaging</subject><subject>Necrosis - etiology</subject><subject>Necrosis - genetics</subject><subject>PATIENTS</subject><subject>Proto-Oncogene Proteins B-raf</subject><subject>Radiation Injuries - complications</subject><subject>Radiation Injuries - diagnostic imaging</subject><subject>Radiation Injuries - pathology</subject><subject>Radiology</subject><subject>RADIOLOGY AND NUCLEAR MEDICINE</subject><subject>Radiosurgery - adverse effects</subject><subject>RADIOTHERAPY</subject><subject>Regression Analysis</subject><subject>Retrospective Studies</subject><subject>SURGERY</subject><issn>0360-3016</issn><issn>1879-355X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkU1v1DAQhi0EokvhHyAUiXOCx5_JBWlblQ-ptBItEjfL60yKw268sr2g_fc4pPTQC5Jla-z3Hc88Q8hroA1QUO_Gxo8xbPYNK1FD24by7glZQau7mkv5_SlZUa5ozcvzCXmR0kgpBdDiOTlhWgsmBV2R3Tql4LzNPkzVGebfiFP11fb3N1foYkg-VXbqq9vDLsTqzIdtuDtW6yFjrG7KhiFbl7376wvpEO8wHqth1kbrp-oLZpvK8ukleTbYbcJX9-cp-fbh4vb8U315_fHz-fqydhIg15wJpSl0igGwfsO0sCXsqVQgrBKaAVWy7XgLToPQlPcbKy1y13EuB6f5KXm75A0pe5Ocz-h-uDBN6LJhTAmpWVdUYlHNPaaIg9lHv7PxaICambEZzcLYzIwNbU1hXGxvFtv-sNlh_2D6B7UI3i8CLC3-8hjnCnBy2Ps4F9AH_78fHidwWz95Z7c_8YhpDIc4FXwGTGKGmpt5zvOYQXEOUij-B5Rmo2Q</recordid><startdate>20161201</startdate><enddate>20161201</enddate><creator>Miller, Jacob A., BS</creator><creator>Bennett, Elizabeth E., MD</creator><creator>Xiao, Roy, BS</creator><creator>Kotecha, Rupesh, MD</creator><creator>Chao, Samuel T., MD</creator><creator>Vogelbaum, Michael A., MD, PhD</creator><creator>Barnett, Gene H., MD, MBA</creator><creator>Angelov, Lilyana, MD</creator><creator>Murphy, Erin S., MD</creator><creator>Yu, Jennifer S., MD, PhD</creator><creator>Ahluwalia, Manmeet S., MD</creator><creator>Suh, John H., MD</creator><creator>Mohammadi, Alireza M., MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>OTOTI</scope></search><sort><creationdate>20161201</creationdate><title>Association Between Radiation Necrosis and Tumor Biology After Stereotactic Radiosurgery for Brain Metastasis</title><author>Miller, Jacob A., BS ; Bennett, Elizabeth E., MD ; Xiao, Roy, BS ; Kotecha, Rupesh, MD ; Chao, Samuel T., MD ; Vogelbaum, Michael A., MD, PhD ; Barnett, Gene H., MD, MBA ; Angelov, Lilyana, MD ; Murphy, Erin S., MD ; Yu, Jennifer S., MD, PhD ; Ahluwalia, Manmeet S., MD ; Suh, John H., MD ; Mohammadi, Alireza M., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c511t-3246701962112db274a701d05614a6472106589381c714703dba5ae3c9335fc73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adenocarcinoma - pathology</topic><topic>Adenocarcinoma - secondary</topic><topic>BIOMEDICAL RADIOGRAPHY</topic><topic>BRAIN</topic><topic>Brain - pathology</topic><topic>Brain - radiation effects</topic><topic>Brain Neoplasms - chemistry</topic><topic>Brain Neoplasms - genetics</topic><topic>Brain Neoplasms - radiotherapy</topic><topic>Brain Neoplasms - secondary</topic><topic>Breast Neoplasms - genetics</topic><topic>Carcinoma, Non-Small-Cell Lung - genetics</topic><topic>Carcinoma, Squamous Cell - genetics</topic><topic>CLINICAL TRIALS</topic><topic>Female</topic><topic>Gene Amplification</topic><topic>Genes, erbB-2</topic><topic>Hematology, Oncology and Palliative Medicine</topic><topic>HISTOLOGY</topic><topic>Humans</topic><topic>Lung Neoplasms - pathology</topic><topic>Male</topic><topic>Melanoma - genetics</topic><topic>Middle Aged</topic><topic>MULTIVARIATE ANALYSIS</topic><topic>NECROSIS</topic><topic>Necrosis - diagnostic imaging</topic><topic>Necrosis - etiology</topic><topic>Necrosis - genetics</topic><topic>PATIENTS</topic><topic>Proto-Oncogene Proteins B-raf</topic><topic>Radiation Injuries - complications</topic><topic>Radiation Injuries - diagnostic imaging</topic><topic>Radiation Injuries - pathology</topic><topic>Radiology</topic><topic>RADIOLOGY AND NUCLEAR MEDICINE</topic><topic>Radiosurgery - adverse effects</topic><topic>RADIOTHERAPY</topic><topic>Regression Analysis</topic><topic>Retrospective Studies</topic><topic>SURGERY</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Miller, Jacob A., BS</creatorcontrib><creatorcontrib>Bennett, Elizabeth E., MD</creatorcontrib><creatorcontrib>Xiao, Roy, BS</creatorcontrib><creatorcontrib>Kotecha, Rupesh, MD</creatorcontrib><creatorcontrib>Chao, Samuel T., MD</creatorcontrib><creatorcontrib>Vogelbaum, Michael A., MD, PhD</creatorcontrib><creatorcontrib>Barnett, Gene H., MD, MBA</creatorcontrib><creatorcontrib>Angelov, Lilyana, MD</creatorcontrib><creatorcontrib>Murphy, Erin S., MD</creatorcontrib><creatorcontrib>Yu, Jennifer S., MD, PhD</creatorcontrib><creatorcontrib>Ahluwalia, Manmeet S., MD</creatorcontrib><creatorcontrib>Suh, John H., MD</creatorcontrib><creatorcontrib>Mohammadi, Alireza M., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>OSTI.GOV</collection><jtitle>International journal of radiation oncology, biology, physics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Miller, Jacob A., BS</au><au>Bennett, Elizabeth E., MD</au><au>Xiao, Roy, BS</au><au>Kotecha, Rupesh, MD</au><au>Chao, Samuel T., MD</au><au>Vogelbaum, Michael A., MD, PhD</au><au>Barnett, Gene H., MD, MBA</au><au>Angelov, Lilyana, MD</au><au>Murphy, Erin S., MD</au><au>Yu, Jennifer S., MD, PhD</au><au>Ahluwalia, Manmeet S., MD</au><au>Suh, John H., MD</au><au>Mohammadi, Alireza M., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association Between Radiation Necrosis and Tumor Biology After Stereotactic Radiosurgery for Brain Metastasis</atitle><jtitle>International journal of radiation oncology, biology, physics</jtitle><addtitle>Int J Radiat Oncol Biol Phys</addtitle><date>2016-12-01</date><risdate>2016</risdate><volume>96</volume><issue>5</issue><spage>1060</spage><epage>1069</epage><pages>1060-1069</pages><issn>0360-3016</issn><eissn>1879-355X</eissn><abstract>Background The primary dose-limiting toxicity of stereotactic radiosurgery (SRS) is radiation necrosis (RN), which occurs after approximately 5% to 10% of treatments. This adverse event may worsen neurologic deficits, increase the frequency and cost of imaging, and necessitate prolonged treatment with steroids or antiangiogenic agents. Previous investigations have primarily identified lesion size and dosimetric constraints as risk factors for RN in small populations. We hypothesized that disease histology, receptor status, and mutational status are associated with RN. Methods and Materials All patients presenting with brain metastasis between 1997 and 2015 who underwent SRS and subsequent radiographic follow-up at a single tertiary-care institution were eligible for inclusion. The primary outcome was the cumulative incidence of radiographic RN. Multivariate competing risks regression was used to identify biological risk factors for RN. Results 1939 patients (5747 lesions) were eligible for inclusion; 285 patients (15%) experienced radiographic RN after the treatment of 427 (7%) lesions. After SRS, the median time to RN was 7.6 months. After multivariate analysis, graded prognostic assessment, renal pathology, lesion diameter, and the heterogeneity index remained independently predictive of RN in the pooled cohort. In subset analyses of individual pathologies, HER2 -amplified status (hazard ratio [HR] 2.05, P =.02), BRAF V600+ mutational status (HR 0.33, P =.04), lung adenocarcinoma histology (HR 1.89, P =.04), and ALK rearrangement (HR 6.36, P <.01) were also associated with RN. Conclusions In the present investigation constituting the largest series of RN, several novel risk factors were identified, including renal histology, lung adenocarcinoma histology, HER2 amplification, and ALK / BRAF mutational status. These risk factors may be used to guide clinical trial design incorporating biological risk stratification or dose escalation. Future studies determining the optimal timing of targeted therapies are warranted to further define the risk of RN.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27742540</pmid><doi>10.1016/j.ijrobp.2016.08.039</doi><tpages>10</tpages></addata></record> |
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| ispartof | International journal of radiation oncology, biology, physics, 2016-12, Vol.96 (5), p.1060-1069 |
| issn | 0360-3016 1879-355X |
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| subjects | Adenocarcinoma - pathology Adenocarcinoma - secondary BIOMEDICAL RADIOGRAPHY BRAIN Brain - pathology Brain - radiation effects Brain Neoplasms - chemistry Brain Neoplasms - genetics Brain Neoplasms - radiotherapy Brain Neoplasms - secondary Breast Neoplasms - genetics Carcinoma, Non-Small-Cell Lung - genetics Carcinoma, Squamous Cell - genetics CLINICAL TRIALS Female Gene Amplification Genes, erbB-2 Hematology, Oncology and Palliative Medicine HISTOLOGY Humans Lung Neoplasms - pathology Male Melanoma - genetics Middle Aged MULTIVARIATE ANALYSIS NECROSIS Necrosis - diagnostic imaging Necrosis - etiology Necrosis - genetics PATIENTS Proto-Oncogene Proteins B-raf Radiation Injuries - complications Radiation Injuries - diagnostic imaging Radiation Injuries - pathology Radiology RADIOLOGY AND NUCLEAR MEDICINE Radiosurgery - adverse effects RADIOTHERAPY Regression Analysis Retrospective Studies SURGERY |
| title | Association Between Radiation Necrosis and Tumor Biology After Stereotactic Radiosurgery for Brain Metastasis |
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