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

被引:112
作者
Ali, Faisal S. [1 ]
Arevalo, Octavio [2 ]
Zorofchian, Soheil [3 ]
Patrizz, Anthony [3 ]
Riascos, Roy [2 ]
Tandon, Nitin [3 ]
Blanco, Angel [3 ]
Ballester, Leomar Y. [4 ]
Esquenazi, Yoshua [3 ]
机构
[1] St Joseph Hosp, Dept Internal Med, Chicago, IL USA
[2] Univ Texas Hlth Sci Ctr Houston, Dept Neuroradiol, McGovern Med Sch, Houston, TX 77030 USA
[3] Univ Texas Hlth Sci Ctr Houston, Vivian L Smith Dept Neurosurg, McGovern Med Sch, Houston, TX 77030 USA
[4] Univ Texas Hlth Sci Ctr Houston, Dept Pathol, McGovern Med Sch, Houston, TX 77030 USA
关键词
Radiotherapy; Radiation necrosis; Brain tumors; Gliomas; Stereotactic radiosurgery; Laser interstitial thermal therapy; Tumor progression; Imaging; Pseudo-progression; Bevacizumab; Biomarkers; GAMMA-KNIFE RADIOSURGERY; MAGNETIC-RESONANCE-SPECTROSCOPY; INTERSTITIAL THERMAL THERAPY; MGMT PROMOTER METHYLATION; HIGH-GRADE GLIOMAS; STEREOTACTIC RADIOSURGERY; BRAIN METASTASES; GLIOBLASTOMA-MULTIFORME; TUMOR RECURRENCE; MALIGNANT GLIOMAS;
D O I
10.1007/s11912-019-0818-y
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose of ReviewCerebral 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 CRNthe genetic profile of the host or the lesion and their role in the development of CRN.Recent FindingsRecent 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 CNR 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.SummaryA 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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页数:17
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