radiation necrosis – what is typical evolution ?

Portal Forums Radiation Oncology Brain Metastases / PCI radiation necrosis – what is typical evolution ?

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May 9, 2017 at 8:29 pm  #1290719    



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 ?

Thanks so much for any recommendations .


May 10, 2017 at 6:48 pm  #1290726    
JimC Forum Moderator
JimC Forum Moderator

Hi Kempten,

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.

Forum moderator

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May 17, 2017 at 7:57 am  #1290741    


thank you Jim for sending the link above.
I did read it and it was very helpful.


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