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Brain Radionecrosis

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Adult CNS Radiation Oncology

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Abstract

Brain radionecrosis can develop following high-dose fractionated or single-fraction radiation treatments. Most commonly, brain radionecrosis is observed following radiosurgery treatments to the brain or high-dose fractionated radiotherapy treatments to brain tumors, base of skull tumors, and head and neck tumors. The clinical presentation of brain radionecrosis will depend on the location of the brain that is involved. Diagnosis of radionecrosis is commonly based on clinical presentation and radiological characteristics, but a gold standard diagnostic tool is not currently available. Even pathological evaluation can be challenged with the presence of both necrosis and tumor cells. Conventionally, patients are typically started on corticosteroids as the initial treatment for symptomatic radionecrosis. In a subset of patients, corticosteroids are ineffective, and some patients may require surgical resection to remove or alternative treatments. Several alternative local and systemic treatments are under evaluation including laser-induced thermal therapy, hyperbaric oxygen therapy, bevacizumab, and edaravone.

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Abbreviations

AUC:

Area under the curve

AVM:

Arteriovenous malformation

CBV:

Cerebral blood volume

CFT:

Category fluency test

Cho:

Choline

CMMSE:

Cantonese version of the Mini-Mental Status Examination

Cr:

Creatine

DCE:

Dynamic contrast-enhanced

DSC:

Dynamic susceptibility-weighted contrast-enhanced

DWI:

Diffusion-weighted imaging

EANO:

European Association of Neuro-Oncology

FDG:

Fluorodeoxyglucose

FLAIR:

Fluid-attenuated inversion recovery

HBOT:

Hyperbaric oxygen therapy

HIF-1α:

Hypoxia-inducible factor-1 alpha

HKLLT:

Hong Kong List Learning Test

HR-QOL:

Health-related quality of life

IMRT:

Intensity-modulated radiotherapy

KPS:

Karnofsky Performance Status

Lac:

Lactate

LENT-SOMA:

Late Effects Normal Tissue Task Force-Subjective, Objective, Management, Analytic

Lip:

Lipid

LITT:

Laser interstitial thermal therapy

MDASI-BT:

MD Anderson Symptom Inventory for brain tumor

MRS:

MR spectroscopy

NAA:

N-Acetylasparate

PSR:

Percent signal recovery

PTX:

Pentoxifylline

RANO:

Response Assessment in Neuro-Oncology Criteria

rCBV:

Relative cerebral blood volume

ROC:

Receiver operating characteristic

ROIs:

Regions of interest

SRS:

Stereotactic radiosurgery

VEGF:

Vascular endothelial growth factor

WMS-III VR:

Visual Reproduction subtest of the Wechsler Memory Scale-III

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Author information

Authors and Affiliations

  1. Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Caroline Chung

  2. Department of Radiology, Mayo Clinic, Rochester, MN, USA

    Timothy J. Kaufmann

Authors
  1. Caroline Chung
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  2. Timothy J. Kaufmann
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Corresponding author

Correspondence to Caroline Chung .

Editor information

Editors and Affiliations

  1. Department of Radiation Oncology, Keck School of Medicine of USC, Norris Cancer Hospital, Los Angeles, California, USA

    Eric L. Chang

  2. Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA

    Paul D. Brown

  3. Department of Radiation Oncology, University of Washington Medical Center, Seattle, Washington, USA

    Simon S. Lo

  4. Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada

    Arjun Sahgal

  5. Department of Radiation Oncology, Taussig Cancer Institute Cleveland Clinic, Cleveland, Ohio, USA

    John H. Suh

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Chung, C., Kaufmann, T.J. (2018). Brain Radionecrosis. In: Chang, E., Brown, P., Lo, S., Sahgal, A., Suh, J. (eds) Adult CNS Radiation Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-42878-9_36

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  • DOI: https://doi.org/10.1007/978-3-319-42878-9_36

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