Hyponatremia is a potential predictor of progression in radiation-induced brain necrosis: a retrospective study

Abstract

BackgroundTo investigate the prognostic value of hyponatremia, defined as serum sodium level < 135 mEq/L, in radiation-induced brain necrosis (RN) patients.MethodsWe performed a retrospective analysis of the RN patients (The patients included in our study had a history of primary cancers including nasopharyngeal carcinoma/glioma/oral cancer and received radiotherapy previously and then were diagnosed with RN) treated in Sun yat-sen Memorial Hospital from January 2013 to August 2015. Patients without cranial magnetic resonance imaging (MRI) scan and serum sodium data were excluded. Progression was identified when the increase of edema area ≥ 25% on the MRI taken in six months comparing with those taken at the baseline. Factors that might associate with prognosis of RN were collected. Multivariable logistic regression analyses were used to identify potential predictors.ResultsWe total included 135 patients, 32 (23.7%) of them with hyponatremia and 36 (26.7%) with RN progression. Percentage of progression was roughly three fold in hyponatremia patients compared with nonhyponatremia patients (53.1% versus 18.4%), translating into a 5-fold increased odds ratio (P < 0.001). Multivariable analyses identified hyponatremia as a potential predictor of progression (OR, 4.82; 95% CI [1.94–11.94]; P = 0.001).ConclusionsHyponatremia was identified as a potential predictor for the progression of patients with RN. Hyponatremia management in patients with RN should be paid much more concern in clinical practice.

Prognostic and predictive role of hyponatremia in cancer patients

“…In a retrospective study performed at a University Hospital in China, among patients affected by nasopharyngeal carcinoma, glioma or oral cancer, that had been subjected to radiotherapy and developed radiation-induced brain necrosis, the risk of progression (i.e., increase of edema area ≥ 25% on the MRI) was three-fold higher in patients with hyponatremia compared to those with normonatremia. Thus, the authors claimed that hyponatremia may be considered as a potential predictor for the progression of radiationinduced brain necrosis and recommended that hyponatremia is appropriately managed also in these patients [26] .…”

Treatment of Radiation‐Induced Brain Necrosis

“…However, previous DTI studies focused on specific brain regions or WM regions in nasopharyngeal carcinoma patients after radiotherapy, and these studies provided information only on the integrity of the brain WM in isolated or 9 Oxidative Medicine and Cellular Longevity predefined WM regions [136]. Hyponatremia was identified as a potential predictor for the progression of patients with RBN [137]. Cai et al [138] have developed a Norfolk study to evaluate the relationship between radiotherapy and cerebral necrosis and found four important predictors: hypertension, statin therapy, serum high-density lipoprotein levels, and the interval between radiotherapy and cerebral necrosis time.…”