Early tumor-related hemorrhage after stereotactic radiosurgery of brain metastases: Systematic review of reported cases

• Published in: Journal of Clinical Neuroscience Vol. 115; pp. 66 - 70
• Main Authors: Maarif, Raisul, Kubota, Yuichi, Chernov, Mikhail F.
• Format: Journal Article
• Language: English
• Published: Scotland Elsevier Ltd 01.09.2023; Elsevier BV
• Subjects: Brain Neoplasms; Brain Neoplasms - radiotherapy; Brain Neoplasms - secondary; Brain Neoplasms - surgery; Carcinoma, Renal Cell; Carcinoma, Renal Cell - surgery; Complication; Hemorrhage; Humans; Kidney Neoplasms; Metastatic brain tumor; Outcome; Radiosurgery; Radiosurgery - adverse effects; Retrospective Studies; Stereotactic radiosurgery; Treatment Outcome; Stereotactic radiosurgery; Complication; Metastatic brain tumor; Hemorrhage; Outcome
• ISSN: 0967-5868; 1532-2653; 1532-2653
• DOI: 10.1016/j.jocn.2023.07.004

•Early tumor-related hemorrhage is very rare, but potentially life-threatening complication of radiosurgery for brain metastases.•Overall, among evaluated series the median rates of this complication were 0.8% per patient (range, 0.4 – 1.9%) and 0.3% per tumor (range, 0.05 – 0.8%).•Out of 11 case reports providing detailed outcome, only 3 patients demonstrated good-to-moderate recovery.•Before radiosurgery, patient and his or her relatives should be informed about risk of early tumor-related hemorrhage and its possible consequences. Early (within 72 h) tumor-related hemorrhage (TRH) after stereotactic radiosurgery (SRS) of brain metastases (BM) has been reported only occasionally. Systematic review of such cases was done. Literature search was performed through PubMed according to PRISMA guidelines using combination of the following medical subject headings: “hemorrhage,” “stereotactic radiosurgery,” and “brain metastasis.” In total, 7 case reports and 8 clinical series, which noted early TRH after SRS of BM were identified. Scarce and inconsistent data precluded their precise synthesis and statistical analysis. BM of renal cell carcinoma comprised around one-third of reported cases. In 4 patients with multiple BM, TRH after SRS was noted simultaneously in several irradiated tumors. Considering 17 reported cases overall, in 3 patients TRH occurred during SRS session itself, in 4 within several minutes upon completion of treatment, in 7 within several hours thereafter, and in 3 on the third posttreatment day. Out of 11 reported cases providing detailed outcome, 6 patients died shortly after the ictus, 2 others were severely disabled at discharge, and 3 demonstrated good-to-moderate recovery. Overall, among evaluated series the median rates of early TRH after SRS for BM were 0.8% per patient (range, 0.4 – 1.9%) and 0.3% per tumor (range, 0.05 – 0.8%). Early TRH is very rare, but potentially life-threatening complication of SRS for BM; thus, its risk (while extremely low) and possible consequences should be discussed at the time of obtaining informed consent.