2024 World Conference on Lung Cancer (WCLC) - Posters-P1.09A.02 Pathologic Tumor Positivity vs Only Necrosis in Clinically Suspected Recurrent Brain Metastasis Post-Radiation

P1.09A.02 Pathologic Tumor Positivity vs Only Necrosis in Clinically Suspected Recurrent Brain Metastasis Post-Radiation

Back to course

Pdf Summary

The study investigates the challenge of differentiating between tumor recurrence and necrosis in patients with recurrent brain metastasis (RBM) who have undergone previous radiation therapy (RT). The difficulty lies in distinguishing these conditions based solely on imaging, as both tumor and necrosis often coexist in pathology. To better understand this issue, researchers examined frozen section pathology results from patients targeted for resection due to suspected RBM following prior same-site RT.<br /><br />From October 2020 to February 2024, 60 patients with 64 lesions underwent open resection and intraoperative pathology evaluation. The study included patients with previous RT for cancers from various primary sites: lung (55%), melanoma (17%), breast (13%), renal (7%), and other cancers (8%). Researchers found varying rates of tumor presence (TUM) and necrosis without tumor (TUM-). Overall, across all types, tumors were present in 88% of cases, while 12% showed only necrosis. Lung cancer cases had the highest TUM- rate at 18%, followed by breast cancer at 13%, and melanoma at 10%.<br /><br />The study emphasizes the importance of pathologic confirmation in treating RBM post-radiation. The findings suggest that additional radiation therapy may not be appropriate if necrosis is confirmed, highlighting the need for targeted surgical intervention. Due to prior systemic therapies (chemotherapy or immunotherapy) which were more prevalent among TUM- patients, necrosis as an RT injury was classified as Grade 4 in severity. The research underscores that a coordinated approach involving prospective pathology and treatment plans like intraoperative cesium-131 collagen tile brachytherapy is critical for effective management of RBM.

Asset Subtitle

Rupesh Kotecha

Meta Tag

Speaker Rupesh Kotecha

Topic Metastatic NSCLC – Local Therapies

Keywords

brain metastasis

tumor recurrence

necrosis

radiation therapy

pathology evaluation

lung cancer

melanoma

breast cancer

surgical intervention

cesium-131 brachytherapy