Radiation Necrosis in Intracranial Lesions

Radiation necrosis (RN) is a challenging potential complication of cranial radiation therapy. Believed to result from a complex interplay of vascular, glial, and immunologic factors, the exact mechanism of RN remains unclear. Patients who develop RN typically have a history of treatment with stereot...

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Bibliographic Details
Published in:Curēus (Palo Alto, CA) CA), 2020-04, Vol.12 (4), p.e7603-e7603
Main Authors: Munier, Sean, Ginalis, Elizabeth E, Patel, Nitesh V, Danish, Shabbar, Hanft, Simon
Format: Article
Language:English
Subjects:
Blood-brain barrier
Brain cancer
Chemotherapy
Cytokines
Edema
Immune system
Medical prognosis
Metastasis
Monoclonal antibodies
Necrosis
Neurosurgery
Oncology
Pathophysiology
Patients
Radiation Oncology
Radiation therapy
Targeted cancer therapy
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Summary:Radiation necrosis (RN) is a challenging potential complication of cranial radiation therapy. Believed to result from a complex interplay of vascular, glial, and immunologic factors, the exact mechanism of RN remains unclear. Patients who develop RN typically have a history of treatment with stereotactic radiation surgery or some other form of radiation-based therapy. The time frame for its development is variable, but it most often occurs one to three years following radiation therapy. Reported treatment doses capable of inducing radiation necrosis are variable, with higher doses per fraction more likely to induce RN. Furthermore, RN remains a challenging diagnosis for clinicians to make, as its presentation is often nonspecific and imaging studies might not clearly differentiate RN from tumor recurrence or pseudoprogression. RN is initially managed with corticosteroids, followed by bevacizumab, surgical resection, or laser interstitial thermal therapy if symptoms persist. In this review, we examine the literature regarding pathophysiology, incidence, imaging characteristics, and management strategies for radiation necrosis.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.7603