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Radiotherapy for the Management of Brain Metastases

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Metastasis".

Deadline for manuscript submissions: 31 May 2026 | Viewed by 2286

Special Issue Editor


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Guest Editor
Department of Radiation Medicine, Lenox Hill Hospital, New York, NY, USA
Interests: brain metastases; radiotherapy; radiation oncology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Advancements in imaging and systemic options have recently led to groundbreaking changes in the treatment of brain metastases. In this issue, “Radiotherapy for the Management of Brain Metastases”, we present modern approaches to patients with brain metastases, the significance of their molecular profiles, systemic treatment options, and radiotherapeutic techniques. We will discuss sequencing or systemic options and radiotherapeutic options, such as primary irradiation and re-irradiation. Senior scholars will discuss state-of-the-art treatment approaches and cutting-edge clinical research.

Dr. Alla Gabriella Wernicke
Guest Editor

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Keywords

  • brain metastases
  • molecular profiles
  • imaging advancements
  • systemic treatment options
  • radiotherapeutic techniques
  • primary irradiation
  • re-irradiation
  • cutting-edge clinical research

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Published Papers (1 paper)

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Review

23 pages, 2004 KB  
Review
Radiation Necrosis in Neuro-Oncology: Diagnostic Complexity and Precision Radiotherapy Strategies
by Laura Mittelman, James Duehr, Jacob S. Kazmi, Luis O. Vargas, Nora Donahue, John Chen, Sandra Leskinen, Shoaib A. Syed, A. Gabriella Wernicke and Randy S. D’Amico
Cancers 2025, 17(21), 3542; https://doi.org/10.3390/cancers17213542 - 1 Nov 2025
Viewed by 2118
Abstract
Background: Radiation necrosis (RN) is a delayed and potentially debilitating complication of radiotherapy for central nervous system (CNS) tumors. It presents significant diagnostic and therapeutic challenges due to the variable clinical manifestations and overlap with tumor recurrence. Although advances in radiotherapy have improved [...] Read more.
Background: Radiation necrosis (RN) is a delayed and potentially debilitating complication of radiotherapy for central nervous system (CNS) tumors. It presents significant diagnostic and therapeutic challenges due to the variable clinical manifestations and overlap with tumor recurrence. Although advances in radiotherapy have improved tumor control, RN remains incompletely understood and inadequately addressed. This narrative review synthesizes current evidence on RN pathophysiology, risk factors, diagnostic strategies, and management approaches. Methods: A literature search was conducted for English-language literature published between January 1990 and December 2024. Studies were included if they addressed RN incidence, diagnosis, treatment, or novel preventive strategies in CNS tumor populations. Relevant findings were synthesized to produce a narrative review summarizing pathophysiology, diagnostic challenges, and treatment strategies. Results: RN results from radiation-induced neurovascular injury, inflammation, and vessel permeability, with incidence ranging from 3 to 26% depending on tumor type, location, and treatment parameters. Risk is influenced by dose, fractionation, cumulative exposure, re-irradiation, and adjuvant therapies. Advanced modalities such as SRS, HFSRT, brachytherapy, proton therapy, and IORT reduce but do not eliminate RN risk. Diagnosis remains challenging despite advanced MRI and PET techniques, with histopathology as the gold standard. Management includes corticosteroids, bevacizumab, surgery, LITT, and experimental therapies. Connectomics-based planning shows promise in minimizing RN by sparing critical brain networks. Conclusions: RN is a clinically significant and multifactorial complication of CNS radiotherapy. Precision treatment modalities and advanced imaging have improved prevention and detection, but diagnostic uncertainty and recurrence risk persist. Integration of connectomics into treatment planning may offer future promise of a reduction in RN-related morbidity by preserving structural and functional network integrity. Full article
(This article belongs to the Special Issue Radiotherapy for the Management of Brain Metastases)
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