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Neurology
Whole brain radiation therapy resulting in radionecrosis: a possible link with radiosensitising chemoimmunotherapy
  1. Sam Ngu1,2,
  2. Cassidy Werner2,3,
  3. Randy S D' Amico2,3 and
  4. A. Gabriella Wernicke2,4,5
  1. 1Department of Hematology/Oncology, Lenox Hill Hospital, New York, New York, USA
  2. 2Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
  3. 3Department of Neurosurgery, Lenox Hill Hospital, New York, New York, USA
  4. 4Department of Radiation Medicine, Lenox Hill Hospital, New York, New York, USA
  5. 5Northwell Health Cancer Institute, New York, New York, USA
  1. Correspondence to Dr A. Gabriella Wernicke; gwernicke{at}northwell.edu

Abstract

Radionecrosis describes a rare but serious complication of radiation therapy. In clinical practice, stereotactic radiosurgery (SRS) is increasingly used in combination with systemic therapy, including chemotherapy, immune checkpoint inhibitor and targeted therapy, either concurrently or sequentially. There is a paucity of literature regarding radionecrosis in patients receiving whole brain radiation therapy (WBRT) alone (without additional SRS) in combination with immunotherapy or targeted therapies. It is observed that certain combinations increase the overall radiosensitivity of the tumorous lesions. We present a rare case of symptomatic radionecrosis almost 1 year after WBRT in a patient with non-squamous non-small cell lung cancer on third-line chemoimmunotherapy. We discuss available research regarding factors that may lead to radionecrosis in these patients, including molecular and genetic profiles, specific drug therapy combinations and their timing or increased overall survival.

  • Neurooncology
  • Neuroimaging
  • Neuro genetics
  • Neurosurgery

https://doi.org/10.1136/bcr-2023-256758

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    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: SN, CDW, RSD, AGW. The following authors gave final approval of the manuscript: SN, CDW, RSD, AGW. Is the patient one of the authors of this manuscript? No.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.