Toxicity of Radiosurgery for Brainstem Metastases WORLD NEUROSURGERY Patel, A., Dong, T., Ansari, S., Cohen-Gadol, A., Watson, G. A., de Moraes, F., Nakamura, M., Murovic, J., Chang, S. D., Hatiboglu, M., Chun, C., Miller, J. C., Lautenschlaeger, T. 2018; 119: E757–E764


Although stereotactic radiosurgery (SRS) is an effective modality in the treatment of brainstem metastases (BSM), radiation-induced toxicity remains a critical concern. To better understand how severe or life-threatening toxicity is affected by the location of lesions treated in the brainstem, a review of all available studies reporting SRS treatment for BSM was performed.Twenty-nine retrospective studies investigating SRS for BSM were reviewed.The rates of grade 3 or greater toxicity, based on the Common Terminology Criteria for Adverse Events, varied from 0 to 9.5% (mean 3.4 ± 2.9%). Overall, the median time to toxicity after SRS was 3 months, with 90% of toxicities occurring before 9 months. A total of 1243 cases had toxicity and location data available. Toxicity rates for lesions located in the medulla were 0.8% (1/131), compared with midbrain and pons, respectively, 2.8% (8/288) and 3.0% (24/811).Current data suggest that brainstem substructure location does not predict for toxicity and lesion volume within this cohort with median tumor volumes 0.04-2.8 cc does not predict for toxicity.

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