Abstract Background Cerebral radiation necrosis (RN) is a frequent adverse event of stereotactic radiotherapy (SRT) for brain metastases. This retrospective, single-center cohort study compares surgical resection with bevacizumab for the management of RN-associated cerebral edema in patients with brain metastases following stereotactic radiotherapy. Methods Data were extracted from the electronic health records of patients 18 years old that were operated or received bevacizumab for metastatic cerebral RN at Erasmus MC. Inclusion criteria were histopathologically confirmed or a clinical and radiological diagnosis of cerebral RN. Primary outcomes included dexamethasone usage, post-treatment edema volume, and adverse event rates. Results Among 62 patients treated with resection and 32 with bevacizumab, both interventions resulted in significant reductions in cerebral edema and dexamethasone usage. Surgical resection resulted in a higher rate of dexamethasone discontinuation (81.0% vs 46.7%, P .0001) and a lower incidence of grade 2 or higher adverse events (3.2% vs 43.8%) than bevacizumab. Overall survival did not differ between groups. Conclusions Surgical resection can serve as a principal therapeutic strategy for RN-associated cerebral edema in appropriately selected cases where procedural risk is deemed acceptable. Prospective studies are warranted to refine criteria for patient selection and to optimize management strategies for RN occurring in the context of brain metastases.
Dijkstra et al. (2026) studied this question.