A clinical decision-support framework to differentiate radiation necrosis from tumor progression in brain…

Cohort studyNeuro-oncology advances· 2026

A clinical decision-support framework to differentiate radiation necrosis from tumor progression in brain metastases.

Beatriz Ocaña-Tienda, Zhao Hui Chen Zhou, Ana Ramos … Víctor M Pérez-García

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Neurosurgical OncologyCohort studyDiagnosisQ1IF 4.0

Model combining tumor growth rate and clinical factors distinguishes radiation necrosis from progression

A clinical decision-support framework to differentiate radiation necrosis from tumor progression in brain metastases.

Beatriz Ocaña-Tienda … Víctor M Pérez-García

Neuro-oncology advances · 2026 · Q1 in Surgery

Background

Differentiating radiation necrosis (radiation necrosis) from tumor progression (tumor progression) after stereotactic radiotherapy (stereotactic radiotherapy) in brain metastases (brain metastases) is a clinically consequential problem, as conventional MRI frequently fails to distinguish between them.

Purpose

The objective of this study was to develop a clinically interpretable, data-driven model that integrates lesion growth dynamics with routinely available clinical variables to improve discrimination between radiation necrosis and tumor progression.

Methods

We retrospectively analyzed 175 brain metastases from 6 institutions.

n = 131

0.92

Results

0.92

Positive predictions were correct 92% of the time for radiation necrosis in external testing.

n = 131

More results

The final model combined β, primary tumor histology, and stereotactic radiotherapy modality.

In the development cohort, the model demonstrated strong discriminative performance (AUC = 0.887).

The model was translated into a freely accessible, web-based tool to facilitate clinical decision-making.

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Conclusion · 1 of 2

By integrating lesion growth dynamics with routine clinical variables, this probability-based framework supports clinically meaningful differentiation between radiation necrosis and tumor progression.

Conclusion · 2 of 2

Its ability to explicitly represent diagnostic uncertainty, together with external validation, highlights its potential utility as a decision-support tool in the management of brain metastases.

A clinical decision-support framework to differentiate radiation necrosis from tumor progression in brain metastases.

A clinical decision-support framework to differentiate radiation necrosis from tumor progression in brain metastases.

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