Toxicity of Radiosurgery for Brainstem Metastases

Ajay Patel, Tuo Dong, Shaheryar Ansari, Aaron Cohen-Gadol, Gordon A. Watson, Fabio Ynoe de Moraes, Masaki Nakamura, Judith Murovic, Steven D. Chang, Mustafa Aziz Hatiboglu, Caroline Chung, James Miller, Tim Lautenschlaeger

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2 Scopus citations


Background: 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. Methods: Twenty-nine retrospective studies investigating SRS for BSM were reviewed. Results: 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). Conclusions: 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.

Original languageEnglish (US)
JournalWorld Neurosurgery
StateAccepted/In press - Jan 1 2018


  • Brainstem
  • Metastasis
  • Stereotactic radiosurgery
  • Toxicity

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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    Patel, A., Dong, T., Ansari, S., Cohen-Gadol, A., Watson, G. A., Moraes, F. Y. D., Nakamura, M., Murovic, J., Chang, S. D., Hatiboglu, M. A., Chung, C., Miller, J., & Lautenschlaeger, T. (Accepted/In press). Toxicity of Radiosurgery for Brainstem Metastases. World Neurosurgery.