Cystic Formation after Stereotactic Radiosurgery of Brain Metastasis.

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Cystic Formation after Stereotactic Radiosurgery of Brain Metastasis.

World Neurosurg. 2018 Mar 15;:

Authors: Alattar AA, Carroll K, Hirshman BR, Joshi RS, Sanghvi P, Chen CC

Abstract
BACKGROUND: Limited information is available on the natural history and etiology of cystic formation after stereotactic radiosurgery (SRS) for brain metastasis (BM). We aimed to characterize the natural history of cyst formation after SRS of BM and analyze potential risk factors.
METHODS: We retrospectively reviewed 214 consecutive patients who underwent 1,106 SRS for BM. Demographic, clinical, dosimetric, and MRI data were reviewed. Statistical analysis was accomplished with Student's t-test, univariate and multivariate logistic regression.
RESULTS: The median age was 61 (range: 19-91), with a median follow-up of 424 days (range: 12-2,934 days). Eleven instances of cyst formation (0.9% of 1,106 treated lesions) were identified at SRS-treated BM sites among 9 patients (two patients developed cysts at independent sites). The median interval between first SRS and first evidence of cyst was 218 days. Seven of the 9 patients (78%) suffered progressive cyst expansion and neurologic decline requiring steroid treatment. Four of these 7 (57%) suffered continued neurologic decline and required surgical fenestration. On univariate analysis, receipt of >4 rounds of SRS was the only variable associated with increased risk of cyst formation (odds ratio 16.58, p= 0.001). This association remained robust after adjusting for length of follow-up (odds ratio 13.59, p=0.003).
CONCLUSIONS: In our experience of 1,106 SRS-treated BM, cyst formation was a rare phenomenon. However, one in three patients who underwent >4 rounds of SRS suffered cyst formation. A high proportion (78%) of SRS-associated cysts progressively expanded and required medical or surgical treatment.; Abbreviations list.

PMID: 29551723 [PubMed - as supplied by publisher]

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