Incidence and clinical course of radionecrosis in children with brain tumors: A 20-year longitudinal observational study

• Published in: Strahlentherapie und Onkologie 2013-09, Vol.189 (9), p.759-764
• Main Authors: Strenger, V., Lackner, H., Mayer, R., Sminia, P., Sovinz, P., Mokry, M., Pilhatsch, A., Benesch, M., Schwinger, W., Seidel, M., Sperl, D., Schmidt, S., Urban, C.
• Format: Article
• Language: English
• Subjects: Adolescent; Austria - epidemiology; Brain Injuries - epidemiology; Brain Neoplasms - epidemiology; Brain Neoplasms - radiotherapy; Child; Child, Preschool; Comorbidity; Female; Humans; Incidence; Infant; Longitudinal Studies; Male; Medicine; Medicine & Public Health; Oncology; Original Article; Radiation Injuries - epidemiology; Radiotherapy; Radiotherapy, Conformal - statistics & numerical data; Risk Assessment; Treatment Outcome; Young Adult
• ISSN: 0179-7158; 1439-099X
• DOI: 10.1007/s00066-013-0408-0

Radionecrosis (RN) in children treated for brain tumors represents a potentially severe long-term complication. Its diagnosis is challenging, since magnetic resonance imaging (MRI) cannot clearly discriminate between RN and tumor recurrence. A retrospective single-center study was undertaken to describe the incidence and clinical course of RN in a cohort of 107 children treated with external radiotherapy (RT) for various brain tumors between 1992 and 2012. During a median follow-up of 4.6 years (range 0.29–20.1 years), RN was implied by suspicious MRI findings in in 5 children (4.7 %), 5–131 months after RT. Suspicion was confirmed histologically (1 patient) or substantiated by FDG positron-emission tomography (FDG-PET, 2 patients) or by FDG-PET and MR spectroscopy (1 patient). Before developing RN, all 5 patients had received cytotoxic chemotherapy in addition to RT. In addition to standard treatment protocols, 2 patients had received further chemotherapy for progression or relapse. Median radiation dose expressed as the biologically equivalent total dose applied in 2 Gy fractions (EQD2) was 51.7 Gy (range 51.0–60.0 Gy). At RN onset, 4 children presented with neurological symptoms. Treatment of RN included resection (n = 1), corticosteroids (n = 2) and a combination of corticosteroids, hyperbaric oxygen (HBO) and bevacizumab (n = 1). One patient with asymptomatic RN was not treated. Complete radiological regression of the lesions was observed in all patients. Clinical symptoms normalized in 3 patients, whereas 2 developed permanent severe neurological deficits. RN represents a severe long-term treatment complication in children with brain tumors. The spectrum of clinical presentation is wide; ranging from asymptomatic lesions to progressive neurological deterioration. FDG-PET and MR spectroscopy may be useful for distinguishing between RN and tumor recurrence. Treatment options in patients with symptomatic RN include conservative management (steroids, HBO, bevacizumab) and surgical resection.