Acta Neurochirurgica

, Volume 154, Issue 2, pp 191–201

Radiation necrosis following treatment of high grade glioma—a review of the literature and current understanding

  • Alan Siu
  • Joshua J. Wind
  • J. Bryan Iorgulescu
  • Timothy A. Chan
  • Yoshiya Yamada
  • Jonathan H. Sherman
Review Article

DOI: 10.1007/s00701-011-1228-6

Cite this article as:
Siu, A., Wind, J.J., Iorgulescu, J.B. et al. Acta Neurochir (2012) 154: 191. doi:10.1007/s00701-011-1228-6

Abstract

Radiation therapy is an integral part of the standard treatment paradigm for malignant gliomas, with proven efficacy in randomized control trials. Radiation treatment is not without risk however, and radiation injury occurs in a certain proportion of patients. Difficulties in differentiating recurrence from radiation injury complicate the treatment course and can compromise care. These complexities are compounded by the recent distinction of two types of radiation injury: pseudoprogression and radiation necrosis, which are likely the result of radiation injury to the tumor and normal tissue, respectively. A thorough understanding of radiation-induced injury offers insights to guide further therapies. We detail the current knowledge of the mechanisms of radiation injury, along with potential targets for therapeutic intervention. Various diagnostic modalities are also described, in addition to the multiple options for treatment within the context of their pathophysiology and clinical efficacy. Radiation therapy is an integral part of the multidisciplinary management of gliomas, and the optimal diagnosis and management of radiation injury is paramount to improving patient outcomes.

Keywords

Radiation necrosisRadiobiologyPseudoprogressionRadiation injuryRadiosurgeryRadiation

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Alan Siu
    • 1
  • Joshua J. Wind
    • 1
  • J. Bryan Iorgulescu
    • 2
  • Timothy A. Chan
    • 3
  • Yoshiya Yamada
    • 3
  • Jonathan H. Sherman
    • 1
    • 4
  1. 1.Department of Neurological SurgeryGeorge Washington University Medical CenterWashingtonUSA
  2. 2.School of MedicineWeill Cornell Medical CollegeNew YorkUSA
  3. 3.Department of Radiation OncologyMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  4. 4.Department of Neurological SurgeryThe George Washington UniversityWashingtonUSA