biostudies-literatureSeidel JANCI NIH HHSNIH HHS199-208https://www.ebi.ac.uk/biostudies/studies/S-EPMC12337231biostudies-literatureUnknown175(1)<h4>Purpose</h4>Immunotherapy and stereotactic radiosurgery (SRS) are frequently combined in the management of brain metastases from non-small cell lung cancer (NSCLC) and melanoma. However, concurrent SRS and dual immune-checkpoint inhibition (ICPI) elevate the risk for symptomatic radionecrosis. As optimal radionecrosis management in the setting of immunotherapy is unknown, we aimed to characterize our institutional approaches and outcomes in patients with biopsy-proven radionecrosis.<h4>Methods</h4>Patients with NSCLC and melanoma brain metastases treated with SRS from 2014 to 2022 were identified from a prospective database. Only cases with biopsy-confirmed radionecrosis were included. The primary outcome was radiographic stabilization following treatment. Secondary outcomes included sJournal of neuro-oncologyManagement outcomes for biopsy-proven radiation necrosis in patients with brain metastases in the era of immune-checkpoint blockade.PMC12337231K38 CA292995K08-CA25604505R38-CA245204R38 CA245204P30 CA014236Fecci PEKomisarow JKirkpatrick JPAlder LSeidel JAReitman ZJAnders CKMullikin TVaios EJSalama AKSSperduto PFloyd SRfalseManagement outcomes for biopsy-proven radiation necrosis in patients with brain metastases in the era of immune-checkpoint blockade.<h4>Purpose</h4>Immunotherapy and stereotactic radiosurgery (SRS) are frequently combined in the management of brain metastases from non-small cell lung cancer (NSCLC) and melanoma. However, concurrent SRS and dual immune-checkpoint inhibition (ICPI) elevate the risk for symptomatic radionecrosis. As optimal radionecrosis management in the setting of immunotherapy is unknown, we aimed to characterize our institutional approaches and outcomes in patients with biopsy-proven radionecrosis.<h4>Methods</h4>Patients with NSCLC and melanoma brain metastases treated with SRS from 2014 to 2022 were identified from a prospective database. Only cases with biopsy-confirmed radionecrosis were included. The primary outcome was radiographic stabilization following treatment. Secondary outcomes included s2025-01-01T00:00:00Z2025 Oct2026-05-07T04:57:21.264Z2026-04-07T22:32:34.366ZS-EPMC123372314052256310.1007/s11060-025-05120-y