Delayed Radiation Necrosis and Evolution of Its Imaging Features Over Time: An Illustrative Case Report

Wen, Jinhang; Tan, Ai Peng; Yong, Clement; Wong, Yen Ling Jocelyn

doi:10.1200/jop.18.00488

Cited by 3 publications

(2 citation statements)

References 7 publications

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“…However, the impact of previous radiation is generally thought to diminish after 3–5 years, especially when considering re-irradiation [ 10 ]. In most patients, cerebral RN after RT becomes apparent 1–2 years after treatment and continues to occur even beyond 5 years [ 11 12 ]. Reports suggest that these changes are often associated with vascular insufficiency, hemorrhage, and continued cystic changes [ 6 7 ].…”

Section: Discussionmentioning

confidence: 99%

Excessively Delayed Radiation Changes After Proton Beam Therapy for Brain Tumors: Report of Two Cases

Han,

Lee,

Han

et al. 2024

Brain Tumor Res Treat

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Delayed cerebral necrosis is a well-known complication of radiation therapy (RT). Because of its irreversible nature, it should be avoided if possible, but avoidance occurs at the expense of potentially compromised tumor control, despite the use of the modern advanced technique of conformal RT that minimizes radiation to normal brain tissue. Risk factors for radiation-induced cerebral necrosis include a higher dose per fraction, larger treatment volume, higher cumulative dose, and shorter time interval (for re-irradiation). The same principle can be applied to proton beam therapy (PBT) to avoid delayed cerebral necrosis. However, conversion of PBT radiation energy into conventional RT is still short of clinical support, compared to conventional RT. Herein, we describe two patients with excessively delayed cerebral necrosis after PBT, in whom follow-up MRI showed no RT-induced changes prior to 3 years after treatment. One patient developed radiation necrosis at 4 years after PBT to the resection cavity of an astroblastoma, and the other developed brainstem necrosis that became symptomatic 6 months after its first appearance on the 3-year follow-up brain MRI. We also discuss possible differences between radiation changes after PBT versus conventional RT.

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Section: Discussionmentioning

confidence: 99%

Excessively Delayed Radiation Changes After Proton Beam Therapy for Brain Tumors: Report of Two Cases

Han,

Lee,

Han

et al. 2024

Brain Tumor Res Treat

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“…Small lesions are typically clearly distinguishable as in- or out-of-field, leading to prompt diagnosis and intervention, if appropriate. Alternatively, larger lesions often demonstrate heterogeneous growth [ 25 ], requiring observation over multiple imaging cycles before a definitive pattern of evolution can be appreciated. Moreover, larger lesions are more likely to contain a mixture of ARE, progressive disease, and necrotic tumor, further complicating their characterization [ 26 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

Adverse radiation effect versus tumor progression following stereotactic radiosurgery for brain metastases: Implications of radiologic uncertainty

Salans,

Ni,

Morin

et al. 2024

J Neurooncol

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Background Adverse radiation effect (ARE) following stereotactic radiosurgery (SRS) for brain metastases is challenging to distinguish from tumor progression. This study characterizes the clinical implications of radiologic uncertainty (RU). Methods Cases reviewed retrospectively at a single-institutional, multi-disciplinary SRS Tumor Board between 2015–2022 for RU following SRS were identified. Treatment history, diagnostic or therapeutic interventions performed upon RU resolution, and development of neurologic deficits surrounding intervention were obtained from the medical record. Differences in lesion volume and maximum diameter at RU onset versus resolution were compared with paired t-tests. Median time from RU onset to resolution was estimated using the Kaplan–Meier method. Univariate and multivariate associations between clinical characteristics and time to RU resolution were assessed with Cox proportional-hazards regression. Results Among 128 lesions with RU, 23.5% had undergone ≥ 2 courses of radiation. Median maximum diameter (20 vs. 16 mm, p < 0.001) and volume (2.7 vs. 1.5 cc, p < 0.001) were larger upon RU resolution versus onset. RU resolution took > 6 and > 12 months in 25% and 7% of cases, respectively. Higher total EQD2 prior to RU onset (HR = 0.45, p = 0.03) and use of MR perfusion (HR = 0.56, p = 0.001) correlated with shorter time to resolution; larger volume (HR = 1.05, p = 0.006) portended longer time to resolution. Most lesions (57%) were diagnosed as ARE. Most patients (58%) underwent an intervention upon RU resolution; of these, 38% developed a neurologic deficit surrounding intervention. Conclusions RU resolution took > 6 months in > 25% of cases. RU may lead to suboptimal outcomes and symptom burden. Improved characterization of post-SRS RU is needed.

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Temozolomide

2019

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Delayed Radiation Necrosis and Evolution of Its Imaging Features Over Time: An Illustrative Case Report

Cited by 3 publications

References 7 publications

Excessively Delayed Radiation Changes After Proton Beam Therapy for Brain Tumors: Report of Two Cases

Excessively Delayed Radiation Changes After Proton Beam Therapy for Brain Tumors: Report of Two Cases

Adverse radiation effect versus tumor progression following stereotactic radiosurgery for brain metastases: Implications of radiologic uncertainty

Temozolomide

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