Brain MRI and regional vulnerabilities to radiation necrosis: investigating the impact of stereotactic radiotherapy in brain metastases treatment
BackgroundRadiation necrosis is a significant late adverse effect of stereotactic radiotherapy (fSRT) for brain metastases, characterized by inflammatory processes and necrotic degeneration of healthy brain tissue.ObjectiveTo evaluate the relationship between the incidence of radiation necrosis and...
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Frontiers Media S.A.
2025-04-01
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| Series: | Frontiers in Radiology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fradi.2025.1554017/full |
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| author | Carlo A. Mallio Carlo A. Mallio Ugo Ferrari Ugo Ferrari Gianfranco Di Gennaro Matteo Pileri Matteo Pileri Caterina Bernetti Caterina Bernetti Enrica Polo Enrica Polo Emma Gangemi Francesca Giannetti Francesca Giannetti Paolo Matteucci Paolo Matteucci Bruno Beomonte Zobel Bruno Beomonte Zobel Edy Ippolito Edy Ippolito Sara Ramella Sara Ramella |
| author_facet | Carlo A. Mallio Carlo A. Mallio Ugo Ferrari Ugo Ferrari Gianfranco Di Gennaro Matteo Pileri Matteo Pileri Caterina Bernetti Caterina Bernetti Enrica Polo Enrica Polo Emma Gangemi Francesca Giannetti Francesca Giannetti Paolo Matteucci Paolo Matteucci Bruno Beomonte Zobel Bruno Beomonte Zobel Edy Ippolito Edy Ippolito Sara Ramella Sara Ramella |
| author_sort | Carlo A. Mallio |
| collection | DOAJ |
| description | BackgroundRadiation necrosis is a significant late adverse effect of stereotactic radiotherapy (fSRT) for brain metastases, characterized by inflammatory processes and necrotic degeneration of healthy brain tissue.ObjectiveTo evaluate the relationship between the incidence of radiation necrosis and the distribution of lesions across different brain regions treated with fSRT, with a focus on the potential involvement of stem cell niches.MethodsWe conducted a post-hoc analysis of two separate prospective datasets consisting of data from 41 patients previously treated for brain metastases at Campus Bio-Medico University Hospital. Patients underwent fSRT using volumetric-modulated arc radiotherapy (VMAT), with MRI data collected pre- and post-treatment. Lesions were assessed for the presence of radiation necrosis based on radiological and clinical criteria, with a specific focus on their proximity to stem cell niches. A mixed-effects logistic regression model, including age and sex as covariates, was used to identify associations between brain region, stem cell niches, and the likelihood of radiation necrosis.ResultsOf 167 lesions observed, 42 (25.1%) were classified as radiation necrosis. The Deep-Periventricular region showed a significantly higher likelihood of radiation necrosis compared to other brain regions (log-OR: 1.25, 95% CI: 0.20–2.30, p = 0.02). Lesions in proximity to stem cell niches were significantly associated with an increased risk of radiation necrosis (log-OR: 1.61, 95% CI: 0.27–2.94, p = 0.018). These findings highlight the differential vulnerability of brain regions and suggest a potential role of stem cell niches in the pathogenesis of radiation necrosis.ConclusionThis study underscores the importance of brain region and stem cell niche involvement in the development of radiation necrosis following stereotactic radiotherapy. These findings might have implications for optimizing radiotherapy planning and developing targeted strategies to mitigate the risk of radiation necrosis. Future research should focus on exploring the molecular mechanisms underlying these associations and evaluating potential neuroprotective interventions. |
| format | Article |
| id | doaj-art-4b6035bd7aa84e8fa7ad818571ae0220 |
| institution | DOAJ |
| issn | 2673-8740 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Radiology |
| spelling | doaj-art-4b6035bd7aa84e8fa7ad818571ae02202025-08-20T03:06:13ZengFrontiers Media S.A.Frontiers in Radiology2673-87402025-04-01510.3389/fradi.2025.15540171554017Brain MRI and regional vulnerabilities to radiation necrosis: investigating the impact of stereotactic radiotherapy in brain metastases treatmentCarlo A. Mallio0Carlo A. Mallio1Ugo Ferrari2Ugo Ferrari3Gianfranco Di Gennaro4Matteo Pileri5Matteo Pileri6Caterina Bernetti7Caterina Bernetti8Enrica Polo9Enrica Polo10Emma Gangemi11Francesca Giannetti12Francesca Giannetti13Paolo Matteucci14Paolo Matteucci15Bruno Beomonte Zobel16Bruno Beomonte Zobel17Edy Ippolito18Edy Ippolito19Sara Ramella20Sara Ramella21Fondazione Policlinico Universitario Campus Bio-Medico, Rome, ItalyResearch Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, ItalyFondazione Policlinico Universitario Campus Bio-Medico, Rome, ItalyResearch Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, ItalyDepartment of Health Sciences, Chair of Medical Statistics, University of Catanzaro “Magna Græcia”, Catanzaro, ItalyFondazione Policlinico Universitario Campus Bio-Medico, Rome, ItalyResearch Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, ItalyFondazione Policlinico Universitario Campus Bio-Medico, Rome, ItalyResearch Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, ItalyFondazione Policlinico Universitario Campus Bio-Medico, Rome, ItalyResearch Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, ItalyDepartment of Human Neurosciences, Sapienza University of Rome, Rome, ItalyFondazione Policlinico Universitario Campus Bio-Medico, Rome, ItalyResearch Unit of Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, ItalyFondazione Policlinico Universitario Campus Bio-Medico, Rome, ItalyResearch Unit of Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, ItalyFondazione Policlinico Universitario Campus Bio-Medico, Rome, ItalyResearch Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, ItalyFondazione Policlinico Universitario Campus Bio-Medico, Rome, ItalyResearch Unit of Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, ItalyFondazione Policlinico Universitario Campus Bio-Medico, Rome, ItalyResearch Unit of Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, ItalyBackgroundRadiation necrosis is a significant late adverse effect of stereotactic radiotherapy (fSRT) for brain metastases, characterized by inflammatory processes and necrotic degeneration of healthy brain tissue.ObjectiveTo evaluate the relationship between the incidence of radiation necrosis and the distribution of lesions across different brain regions treated with fSRT, with a focus on the potential involvement of stem cell niches.MethodsWe conducted a post-hoc analysis of two separate prospective datasets consisting of data from 41 patients previously treated for brain metastases at Campus Bio-Medico University Hospital. Patients underwent fSRT using volumetric-modulated arc radiotherapy (VMAT), with MRI data collected pre- and post-treatment. Lesions were assessed for the presence of radiation necrosis based on radiological and clinical criteria, with a specific focus on their proximity to stem cell niches. A mixed-effects logistic regression model, including age and sex as covariates, was used to identify associations between brain region, stem cell niches, and the likelihood of radiation necrosis.ResultsOf 167 lesions observed, 42 (25.1%) were classified as radiation necrosis. The Deep-Periventricular region showed a significantly higher likelihood of radiation necrosis compared to other brain regions (log-OR: 1.25, 95% CI: 0.20–2.30, p = 0.02). Lesions in proximity to stem cell niches were significantly associated with an increased risk of radiation necrosis (log-OR: 1.61, 95% CI: 0.27–2.94, p = 0.018). These findings highlight the differential vulnerability of brain regions and suggest a potential role of stem cell niches in the pathogenesis of radiation necrosis.ConclusionThis study underscores the importance of brain region and stem cell niche involvement in the development of radiation necrosis following stereotactic radiotherapy. These findings might have implications for optimizing radiotherapy planning and developing targeted strategies to mitigate the risk of radiation necrosis. Future research should focus on exploring the molecular mechanisms underlying these associations and evaluating potential neuroprotective interventions.https://www.frontiersin.org/articles/10.3389/fradi.2025.1554017/fullbrain MRIradiation necrosisstem cell nichesstereotactic radiotherapybrain metastases |
| spellingShingle | Carlo A. Mallio Carlo A. Mallio Ugo Ferrari Ugo Ferrari Gianfranco Di Gennaro Matteo Pileri Matteo Pileri Caterina Bernetti Caterina Bernetti Enrica Polo Enrica Polo Emma Gangemi Francesca Giannetti Francesca Giannetti Paolo Matteucci Paolo Matteucci Bruno Beomonte Zobel Bruno Beomonte Zobel Edy Ippolito Edy Ippolito Sara Ramella Sara Ramella Brain MRI and regional vulnerabilities to radiation necrosis: investigating the impact of stereotactic radiotherapy in brain metastases treatment Frontiers in Radiology brain MRI radiation necrosis stem cell niches stereotactic radiotherapy brain metastases |
| title | Brain MRI and regional vulnerabilities to radiation necrosis: investigating the impact of stereotactic radiotherapy in brain metastases treatment |
| title_full | Brain MRI and regional vulnerabilities to radiation necrosis: investigating the impact of stereotactic radiotherapy in brain metastases treatment |
| title_fullStr | Brain MRI and regional vulnerabilities to radiation necrosis: investigating the impact of stereotactic radiotherapy in brain metastases treatment |
| title_full_unstemmed | Brain MRI and regional vulnerabilities to radiation necrosis: investigating the impact of stereotactic radiotherapy in brain metastases treatment |
| title_short | Brain MRI and regional vulnerabilities to radiation necrosis: investigating the impact of stereotactic radiotherapy in brain metastases treatment |
| title_sort | brain mri and regional vulnerabilities to radiation necrosis investigating the impact of stereotactic radiotherapy in brain metastases treatment |
| topic | brain MRI radiation necrosis stem cell niches stereotactic radiotherapy brain metastases |
| url | https://www.frontiersin.org/articles/10.3389/fradi.2025.1554017/full |
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