Pathophysiology, Diagnosis, and Treatment of Radiation Necrosis in the Brain

New radiation modalities have made it possible to prolong the survival of individuals with malignant brain tumors, but symptomatic radiation necrosis becomes a serious problem that can negatively affect a patient’s quality of life through severe and lifelong effects. Here we review the relevant lite...

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Published inNeurologia medico-chirurgica Vol. 55; no. 1; pp. 50 - 59
Main Authors MIYATAKE, Shin-Ichi, NONOGUCHI, Noasuke, FURUSE, Motomasa, YORITSUNE, Erina, MIYATA, Tomo, KAWABATA, Shinji, KUROIWA, Toshihiko
Format Journal Article
LanguageEnglish
Published Japan The Japan Neurosurgical Society 01.01.2015
THE JAPAN NEUROSURGICAL SOCIETY
Subjects
Animals
bevacizumab
Brain Neoplasms - radiotherapy
Disease Progression
Humans
Necrosis - therapy
positron emission tomography
pseudoprogression
Radiation Injuries - diagnosis
Radiation Injuries - physiopathology
Radiation Injuries - therapy
radiation necrosis
Review
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Summary:New radiation modalities have made it possible to prolong the survival of individuals with malignant brain tumors, but symptomatic radiation necrosis becomes a serious problem that can negatively affect a patient’s quality of life through severe and lifelong effects. Here we review the relevant literature and introduce our original concept of the pathophysiology of brain radiation necrosis following the treatment of brain, head, and neck tumors. Regarding the pathophysiology of radiation necrosis, we introduce two major hypotheses: glial cell damage or vascular damage. For the differential diagnosis of radiation necrosis and tumor recurrence, we focus on the role of positron emission tomography. Finally, in accord with our hypothesis regarding the pathophysiology, we describe the promising effects of the anti-vascular endothelial growth factor antibody bevacizumab on symptomatic radiation necrosis in the brain.
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There is no conflict of interest to disclose for any of the authors.
Conflicts of Interest Disclosure
ISSN:0470-8105
1349-8029
DOI:10.2176/nmc.ra.2014-0188