I had SRS to 3 leftover brain mets 18 months ago and now have had several MRI’s that showed what might be radiation necrosis or true progression . I have shown no CNS symptoms .
All 3 previously treated lesions show increased edema .
No new visible brain mets have developed since SRS 18 months ago. I continue to take Tagrisso 80 mg orally.
My question is :
What is the most common evolution of RN if untreated ? Does it ever resolve on its own ?
If the tendency is continued worsening of the edema, what would the next step be ?
Could a short course of corticosteroid treatment resolve the inflammation permanently ( if it is RN ) or will the inflammation return after corticosteroid treatment has been discontinued ?
Is surgery ever recommended in asymptomatic patients ?
I’m sorry to hear of this latest complication. Dr. Loiselle has addressed the issue of radiation necrosis previously. He states that asymptomatic necrosis is usually not a problem and often resolves, possibly after the use of a steroid such as Decadron, which can over time be tapered. You can read his comments here (he has additional comments later in the same thread).
Hope that helps, and that the edema reduces soon.
Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa