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Diagnosis and management of brain radiation necrosis. | LitMetric

Diagnosis and management of brain radiation necrosis.

Cancer Radiother

Radiation Oncology Department, CHU de Brest, boulevard Tanguy-Prigent, Brest, France; Inserm, LaTIM UMR 1101, université de Bretagne occidentale, Brest, France.

Published: November 2024

AI Article Synopsis

  • Brain radiation necrosis (BRN) is a serious complication of stereotactic radiotherapy, making it crucial to differentiate it from tumor recurrence using advanced diagnostic techniques.
  • BRN often appears months to years after treatment, with symptoms and MRI changes, influenced by factors like the amount of brain tissue irradiated and radiation dose.
  • Management strategies vary; asymptomatic cases may require monitoring, while symptomatic BRN typically responds to corticosteroids, and emerging treatments like bevacizumab show promise; ongoing research aims to improve outcomes for patients.

Article Abstract

Brain radiation necrosis (BRN) is a significant and complex side effect of stereotactic radiotherapy (SRT). Differentiating BRN from local tumor recurrence is critical, requiring advanced diagnostic techniques and a multidisciplinary approach. BRN typically manifests months to years post-treatment, presenting with radiological changes on MRI and may produce neurological symptoms. Key risk factors include the volume of irradiated brain tissue, the radiation dose, and prior radiotherapy history. This manuscript reviews the diagnostic process for BRN, emphasizing the importance of assessing baseline risk, clinical evaluation, and advanced imaging modalities. Multimodal imaging enhances diagnostic accuracy and aids in distinguishing BRN from tumor relapse. Therapeutic management varies based on symptoms. Asymptomatic BRN may be monitored with regular imaging, while symptomatic BRN often requires corticosteroids to reduce inflammation. Emerging therapies like bevacizumab have shown promise in clinical trials, with significant radiographic and symptomatic improvement. Surgical intervention may be necessary for histological confirmation and severe, treatment-resistant cases. Ongoing research aims to improve diagnostic accuracy and treatment efficacy, enhancing patient outcomes and quality of life. This review underscores the need for a multidisciplinary approach and continuous advancements to address the challenges posed by BRN in brain tumor patients.

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.canrad.2024.07.014DOI Listing

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