{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T13:10:36Z","timestamp":1782738636029,"version":"3.54.5"},"reference-count":44,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,11,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Radiation necrosis (RN) is a well-recognized late complication most commonly occurring within 2 years of stereotactic radiosurgery (SRS); however, late RN (LRN), RN occurring or recurring &gt; 5 years after SRS, has been poorly described. This study analyzes the incidence of and risk factors for LRN occurring &gt; 5 years after SRS.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>This retrospective analysis included patients treated with linear accelerator\u2013based SRS for tumors or arteriovenous malformations with &gt; 5 years of clinical and serial MRI follow-up. LRN was defined as new neurological symptoms with neuroanatomically correlated imaging findings without disease recurrence. Univariate and multivariate analyses for LRN were performed using the Cox proportional hazards model.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>The authors identified a cumulative 297 lesions in 219 patients treated to a median dose of 17 Gy with a median follow-up of 7.4 years. In total, 290 (97.6%) lesions were treated in a single fraction, and 64 (21.5%) were treated after resection. The LRN occurred in 19 (8.7%) patients and in 23 (7.7%) lesions at a median of 6.1 years (range 5.1\u201313.9 years) after SRS. Fifteen of the 23 (65.2%) lesions were managed with steroids, bevacizumab, and\/or antiepileptic drugs. The remaining 8 (34.8%) were resected; histopathology confirmed necrosis without disease recurrence in each. On multivariate analysis, only &gt; 5-cm<jats:sup>3<\/jats:sup> volume of the brain receiving 12 Gy (brain V12<jats:sub>Gy<\/jats:sub>) (HR 6.01, 95% CI 1.77\u201320.48; p = 0.004) and a history of early, previously resolved RN (HR 9.53, 95% CI 2.00\u201345.61; p = 0.005) remained significantly associated with LRN.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>RN risk persists well beyond 5 years after SRS, and recognizing LRN as an entity has important implications in managing these patients. LRN risk was highest in those with a brain V12<jats:sub>Gy<\/jats:sub> &gt; 5 cm<jats:sup>3<\/jats:sup> and a history of early RN after SRS, warranting close follow-up in perpetuity for select patients.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2024.6.jns232187","type":"journal-article","created":{"date-parts":[[2024,11,2]],"date-time":"2024-11-02T01:32:07Z","timestamp":1730511127000},"page":"1-8","source":"Crossref","is-referenced-by-count":6,"title":["Risk of late radiation necrosis more than 5 years after stereotactic radiosurgery"],"prefix":"10.3171","author":[{"given":"Neal S.","family":"McCall","sequence":"first","affiliation":[{"name":"Departments of Radiation Oncology and"},{"name":"Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annabel","family":"Lu","sequence":"additional","affiliation":[{"name":"Departments of Radiation Oncology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin D.","family":"Hopkins","sequence":"additional","affiliation":[{"name":"Departments of Radiation Oncology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Qian","sequence":"additional","affiliation":[{"name":"Departments of Radiation Oncology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly B.","family":"Hoang","sequence":"additional","affiliation":[{"name":"Neurosurgery, Winship Cancer Institute of Emory University, Atlanta, Georgia; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey J.","family":"Olson","sequence":"additional","affiliation":[{"name":"Neurosurgery, Winship Cancer Institute of Emory University, Atlanta, Georgia; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jim","family":"Zhong","sequence":"additional","affiliation":[{"name":"Departments of Radiation Oncology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bree R.","family":"Eaton","sequence":"additional","affiliation":[{"name":"Departments of Radiation Oncology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui-Kuo G.","family":"Shu","sequence":"additional","affiliation":[{"name":"Departments of Radiation Oncology and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"20","key":"b1","series-title":"Neurology","first-page":"917","article-title":"Brain arteriovenous malformations: a review of natural history, pathobiology, and interventions","volume":"95","author":"Chen CJ","year":"2020","unstructured":"Chen CJ, Ding D, Derdeyn CP,  Brain arteriovenous malformations: a review of natural history, pathobiology, and interventions. 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