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01-08-2019 | Glioma | Neuro-oncology (Y Umemura, Section Editor)

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

Authors: Faisal S. Ali, Octavio Arevalo, Soheil Zorofchian, Anthony Patrizz, Roy Riascos, Nitin Tandon, Angel Blanco, Leomar Y. Ballester, Yoshua Esquenazi

Published in: Current Oncology Reports | Issue 8/2019

Abstract

Purpose of Review

Cerebral 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 CRN—the genetic profile of the host or the lesion and their role in the development of CRN.

Recent Findings

Recent 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 CRN 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.

Summary

A 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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Title: Cerebral Radiation Necrosis: Incidence, Pathogenesis, Diagnostic Challenges, and Future Opportunities
Authors: Faisal S. Ali
Octavio Arevalo
Soheil Zorofchian
Anthony Patrizz
Roy Riascos
Nitin Tandon
Angel Blanco
Leomar Y. Ballester
Yoshua Esquenazi
Publication date: 01-08-2019
Publisher: Springer US
Keywords: Glioma
Glioma
Brain Tumor
Radiotherapy
Glioma
Thermal Therapy
Bevacizumab
Laser
Published in: Current Oncology Reports / Issue 8/2019
Print ISSN: 1523-3790
Electronic ISSN: 1534-6269
DOI: https://doi.org/10.1007/s11912-019-0818-y

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