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Cerebral Radiation Necrosis: Incidence, Pathogenesis, Diagnostic Challenges, and Future Opportunities

  • Neuro-oncology (Y Umemura, Section Editor)
  • Published:
Current Oncology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Cerebral radiation necrosis (CRN) is a major dose-limiting adverse event of radiotherapy. The incidence rate of RN varies with the radiotherapy modality, total dose, dose fractionation, and the nature of the lesion being targeted. In addition to these known and controllable features, there is a stochastic component to the occurrence of CRN—the genetic profile of the host or the lesion and their role in the development of CRN.

Recent Findings

Recent studies provide some insight into the genetic mechanisms underlying radiation-induced brain injury. In addition to these incompletely understood host factors, the diagnostic criteria for CRN using structural and functional imaging are also not clear, though multiple structural and functional imaging modalities exist, a combination of which may prove to be the ideal diagnostic imaging approach. As the utilization of novel molecular therapies and immunotherapy increases, the incidence of CRN is expected to increase and its diagnosis will become more challenging. Tissue biopsies can be insensitive and suffer from sampling biases and procedural risks. Liquid biopsies represent a promising, accurate, and non-invasive diagnostic strategy, though this modality is currently in its infancy.

Summary

A better understanding of the pathogenesis of CRN will expand and optimize the diagnosis and management of CRN by better utilizing existing treatment options including bevacizumab, pentoxifylline, hyperbaric oxygen therapy, and laser interstitial thermal therapy.

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Authors and Affiliations

  1. Department of Internal Medicine, Saint Joseph Hospital, Chicago, IL, USA

    Faisal S. Ali

  2. Department of Neuroradiology, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA

    Octavio Arevalo & Roy Riascos

  3. Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center, McGovern Medical School, Houston, TX, 77030, USA

    Soheil Zorofchian, Anthony Patrizz, Nitin Tandon, Angel Blanco & Yoshua Esquenazi

  4. Department of Pathology, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, 77030, USA

    Leomar Y. Ballester

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  1. Faisal S. Ali
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Ali, F.S., Arevalo, O., Zorofchian, S. et al. Cerebral Radiation Necrosis: Incidence, Pathogenesis, Diagnostic Challenges, and Future Opportunities. Curr Oncol Rep 21, 66 (2019). https://doi.org/10.1007/s11912-019-0818-y

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