Cerebral radiation necrosis: Incidence, outcomes, and risk factors with emphasis on radiation parameters and chemotherapy

Ruben, Jeremy; Dally, Michael; Bailey, Michael; Smith, Robin; McLean, Catriona; Fedele, Pasqual

doi:10.1016/j.ijrobp.2005.12.002

Cited by 429 publications

(293 citation statements)

References 65 publications

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“…Prior reports have suggested that particular chemotherapeutic agents have interacted with radiation to increase the risk of radiation necrosis [6]. In recent reports, patients with primary malignant astrocytomas treated with temozolomide and radiotherapy have an up to fourfold increase in radiation necrosis compared to patients receiving radiation therapy alone [1,[7][8][9]. Our patient was treated with high dose melphalan which, as an alkylating agent, has a similar mechanism of action and is known to be a radiosensitizer [10,11].…”

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confidence: 66%

“…Known risk factors include the total radiation dose, fraction size, treatment duration, irradiated volume, and concurrent chemotherapy [1,2]. Although high doses of focal radiation, such as in stereotactic radiosurgery or brachytherapy, are most commonly associated with radiation necrosis, it can also be a complication of external beam radiation therapyespecially when the target lesion is malignant and concurrent chemotherapy is used.…”

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confidence: 99%

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Necrosis following skull base irradiation and stem cell transplant for multiple myeloma

et al. 2010

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A 58-year-old Caucasian man with no significant past medical history presented with rapid onset diplopia and blurred vision. Neurological examination revealed bilateral sixth as well as right fourth and fifth cranial nerve palsies, with no other focal neurological deficits. MRI of the head revealed a 6.0 cm 3 4.7 cm 3 3.2 cm soft tissue mass in the sella turcica, replacing most of the clivus and enhancing strongly after gadolinium administration (see Image 1). The radiological differential diagnosis of the tumor included a clival chordoma, an atypical invasive pituitary adenoma, a solitary plasmacytoma or a bone metastasis. Pituitary function testing demonstrated a markedly elevated serum prolactin (1994 ng/dL, normal 3-13 ng/dL), and bromocriptine therapy was initiated. The patient returned 1 month later with anorexia, nausea, fatigue, and new headache. Blood tests revealed renal dysfunction (creatinine 2.34 mg/dL, normal 0.7-1.2 mg/dL) and hypercalcemia (11.96 mg/dL, normal 8.5-10.3 mg/dL), with a decrease in prolactin (411 ng/dL, normal 2.1-17.7 ng/mL). A renal biopsy revealed nonspecific changes, while urine protein electrophoresis showed large free kappa monoclonal peaks. Bone marrow aspirates showed areas with 40-100% plasmocytes. Hemoglobin was 148 g/L (normal 140-180 g/L), b2-microglubulin 6.2 mg/L (normal 0-2.5 mg/L) and albumin 34 g/L (normal 38-50 g/L). A skeletal survey demonstrated multiple lytic lesions. These new findings were diagnostic of kappa light chain myeloma, ISS Stage III. A transsphenoidal debulking of the sellar lesion was performed, revealing a collision tumor consisting of a prolactinoma and a plasmacytoma. Treatment for MM was initiated with thalidomide and dexamethasone, with supportive pamidronate.After surgery, the patient was referred to radiation oncology for consideration of radiation therapy for palliation of worsening cranial nerve deficits. A total of 50.4 Gy in 28 daily fractions was delivered using a multifield intensitymodulated photon plan (1.8 Gy/fraction). The treatment was well tolerated with subtle improvement of the right fifth cranial nerve deficit. On a contrast-enhanced MRI performed 3 months later, the lesion appeared largely necrotic and was decreased in size. Six months after completion of radiation therapy, the patient underwent an autologous stem cell transplant following stem cell mobilization with cyclophosphamide and G-CSF, and melphalan 200 mg/m 2 .One year post radiotherapy, the patient presented with a 10-day history of lethargy, nausea and vomiting, new complete left seventh nerve palsy, decreased hearing on the left side, and a left third nerve deficit. A repeat CT scan revealed an unchanged clival lesion, and a new hypodensity at the left cerebellopontine angle measuring 4.8 cm 3 2.6 cm, compressing the left cerebellar peduncle and 4th ventricle. An MRI showed new high signal intensity on T2 images involving the left side of the medulla, left inferior and middle cerebellar peduncles, left pons, and left cerebral peduncle. The abnormal signal involve...

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confidence: 66%

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confidence: 99%

Necrosis following skull base irradiation and stem cell transplant for multiple myeloma

et al. 2010

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“…Incidence of radiation necrosis varied from 2.8 % to 24% depending on total dose, dose per fraction, fractionation schedule and type of chemotherapy. [5] To distinguish LDTI from tumor recurrence, as both are contrast enhancing lesions is one of the most serious problems in the long term follow-up of patients with brain tumors after treatment. Novel imaging MRI techniques such as pMRI, DWI and MRS could make the radiological findings more specific and distinguish between tumor progression and radiation necrosis.…”

Section: Discussionmentioning

confidence: 99%

Post-therapeutical changes in the brain: novel trends in imaging and their infuence on external beam radiotherapy

Chorváth¹,

Bolješíková²,

Pruzincová³

et al. 2009

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Presented is the analysis of patients who underwent external beam radiotherapy (EBRT) to the brain in the period from 2003 to 2006 at the department of Radiation Oncology of the St. Elisabeth Cancer Institute.The aim of our analysis was to identify risk factors of late delayed therapy induced injuries (LDTI) in the brain. The patients were regularly examined with magnetic resonance (MRI), including conventional and advanced techniques: perfusion imaging (pMRI), diffusion weighted imaging (DWI), MRI spectroscopy (MRS). The results from MRI were correlated with 18 fluoro-deoxyglucose positron emission tomography ( 18 FDG/PET) scans, as none of the listed method is sufficiently sensitive and specific by itself. Also clinical data records and treatment plans of these patients were analyzed.In our cohort we found 6 patients with abnormal post-therapeutical changes, 4 of them with MR and 18 FDG/PET scans characteristics for LDTI -radiation necrosis. In one patient biopsy was performed and radiation necrosis (RN) was confirmed.

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“…Late vascular changes include vessel wall thickening, with resulting occlusive vasculopathy, perivascular parenchymal coagulative necrosis, and inflammation. Late delayed reactions are reported to occur in 3-24% of patients from 3 months to 13 years after the completion of RT (23)(24)(25)(26). The risk increases with increasing radiation dose, fraction size, irradiated volume, and the (concomitant) administration of chemotherapy (24).…”

Section: Differentiation Between Treatment-related Effects and Glioblmentioning

confidence: 99%

“…Late delayed reactions are reported to occur in 3-24% of patients from 3 months to 13 years after the completion of RT (23)(24)(25)(26). The risk increases with increasing radiation dose, fraction size, irradiated volume, and the (concomitant) administration of chemotherapy (24). The pattern of radiation injury may vary from diffuse periventricular white matter lesions to focal or multifocal lesions and may occur even distant from the original site of treatment (27).…”

Section: Differentiation Between Treatment-related Effects and Glioblmentioning

confidence: 99%

PET for Therapy Response Assessment in Glioblastoma

et al. 2017

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Glioblastoma (GB) is the most malignant and the most common type of glioma in adults, accounting for 60-70% of all malignant gliomas. Despite the current therapy, the clinical course of GB is usually rapid, with a mean survival time of approximately 1 year. For therapy response assessment in GB, magnetic resonance imaging (MRI) is the method of choice. In 2010, the Response Assessment in Neuro-Oncology (RANO) was introduced, including the tumor size (in 2D) as measured on T2-weighted and Fluid Attenuated Inversion Recovery (FLAIR)-weighted images, in addition to the contrast-enhancing tumor part. Although the RANO criteria addressed some of the limitations of the previous MacDonald criteria for therapy evaluation in high-grade glioma, treatment-related side effects hamper correct response assessment. To address the above-mentioned drawbacks in the follow-up of GB, incorporating changes in tumor biology measured by advanced MRI and positron emission tomography (PET) imaging, which may precede anatomical changes of the tumor volume, is promising. Imaging biomarkers capable of predicting response at an early time point after treatment initiation are the premise of personalized treatment enabling change or GB Treatment Response Using PET 176 discontinuation of therapy to prevent ineffective treatment or adverse events of treatment. In this chapter, an overview of applicable PET tracers for the therapy response assessment in GB and the determination of tumor recurrence versus treatment-related effects is given.

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Cerebral radiation necrosis: Incidence, outcomes, and risk factors with emphasis on radiation parameters and chemotherapy

Cited by 429 publications

References 65 publications

Necrosis following skull base irradiation and stem cell transplant for multiple myeloma

Necrosis following skull base irradiation and stem cell transplant for multiple myeloma

Post-therapeutical changes in the brain: novel trends in imaging and their infuence on external beam radiotherapy

PET for Therapy Response Assessment in Glioblastoma

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