Stereotactic radiosurgery (SRS) provides excellent control in the treatment of brain metastases (BM). The use of newer, targeted and immunotherapy treatments have resulted in improved overall survival in patients even with an extensive metastatic disease. Hence, it is increasingly important to consider the potential for late toxicities like radiation-induced necrosis (RN) of the brain. We present a case of a patient with stage IV anaplastic lymphoma kinase (ALK) positive adenocarcinoma of the lung who underwent stereotactic radiosurgery to her brain metastases and received targeted treatment. While her intracranial and extracranial disease remained well controlled, we discuss the radiation-induced necrosis she suffered as a result of the treatment, the related diagnostic dilemma involved, and the subsequent management of this late toxicity of stereotactic radiosurgery.
Keywords: alk-positive adenocarcinoma; brain metastasis; immunotherapy; laser interstitial thermotherapy; non-small cell lung cancer; radiation necrosis; srs; stereotactic radiosurgery.