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Excessively Delayed Radiation Changes After Proton Beam Therapy for Brain Tumors: Report of Two Cases. | LitMetric

AI Article Synopsis

  • - Delayed cerebral necrosis is a serious complication from radiation therapy that is hard to reverse, making it important to minimize this risk while still effectively treating tumors through advanced techniques like conformal radiation therapy (RT).
  • - Factors that increase the risk of developing radiation-induced cerebral necrosis include higher doses of radiation, larger treatment areas, cumulative doses, and shorter intervals between treatments, which are relevant for both conventional and proton beam therapy (PBT).
  • - The text presents two patient cases of delayed cerebral necrosis following PBT, with MRI scans showing no signs of radiation changes until several years post-treatment, raising questions about the differences between effects from PBT and conventional RT.

Article Abstract

Delayed cerebral necrosis is a well-known complication of radiation therapy (RT). Because of its irreversible nature, it should be avoided if possible, but avoidance occurs at the expense of potentially compromised tumor control, despite the use of the modern advanced technique of conformal RT that minimizes radiation to normal brain tissue. Risk factors for radiation-induced cerebral necrosis include a higher dose per fraction, larger treatment volume, higher cumulative dose, and shorter time interval (for re-irradiation). The same principle can be applied to proton beam therapy (PBT) to avoid delayed cerebral necrosis. However, conversion of PBT radiation energy into conventional RT is still short of clinical support, compared to conventional RT. Herein, we describe two patients with excessively delayed cerebral necrosis after PBT, in whom follow-up MRI showed no RT-induced changes prior to 3 years after treatment. One patient developed radiation necrosis at 4 years after PBT to the resection cavity of an astroblastoma, and the other developed brainstem necrosis that became symptomatic 6 months after its first appearance on the 3-year follow-up brain MRI. We also discuss possible differences between radiation changes after PBT versus conventional RT.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11096628PMC
http://dx.doi.org/10.14791/btrt.2024.0017DOI Listing

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