Differentiating radiation necrosis from tumor recurrence: a systematic review and diagnostic meta-analysis comparing imaging modalities

Smith, Emily J.; Naik, Anant; Shaffer, Annabelle; Goel, Mahima; Krist, David T.; Liang, Edward Dilong; Furey, Charuta G.; Miller, W.K.; Lawton, Michael T.; Barnett, Daniel H.; Weis, Blake; Rizk, Ahmed; Smith, Ron S.; Hassaneen, Wael

doi:10.1007/s11060-023-04262-1

Cited by 9 publications

(8 citation statements)

References 24 publications

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“…One of the complications associated with standard treatments for aggressive brain tumors is cerebral RN associated with whole-brain radiation, which can occur anywhere from 2 to 32 months after initiation of the therapy. 11 Such risks are compounded by the inclusion of adjuvant chemotherapy regimens, raising the risk by a factor of five. 12 This complication is of particular concern to clinicians since the clinical and radiological presentation of a patient with RN is nonspecific and can resemble that of a patient with tumor recurrence.…”

Section: Discussionmentioning

confidence: 99%

“… 12 This complication is of particular concern to clinicians since the clinical and radiological presentation of a patient with RN is nonspecific and can resemble that of a patient with tumor recurrence. 11 What is even more challenging is the fact that both pathologies could present simultaneously, further complicating disease management. Timely management is imperative because an early operative approach for tumor recurrence may improve a patient’s overall survival.…”

Section: Discussionmentioning

confidence: 99%

“… 12 , 15 Imaging modalities play a significant role in differentiating between both pathologies and could guide treatment for patients suspected of having a recurrence versus RN or both. For example, in a recent systematic review and diagnostic meta-analysis by Smith et al., 11 who compared various imaging modalities to differentiate tumor recurrence and RN, single photon emission computed tomography and MR spectroscopy performed the best for differentiating both pathologies, with a pooled sensitivity and specificity of 88.7%, 88.3%, 90.7%, and 84.1%, respectively.…”

Section: Discussionmentioning

confidence: 99%

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Operative planning for a functional precision medicine assay of recurrent high-grade glioma: illustrative case

Mathews,

Shelton,

Horta

et al. 2024

Journal of Neurosurgery: Case Lessons

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BACKGROUND Functional precision medicine (FPM) represents a personalized and efficacious modality for treating malignant neoplasms. However, acquiring sufficient live tissue to perform FPM analyses is complicated by both difficult identification on imaging and radiation necrosis, particularly in cases of recurrence. The authors describe a case of planning biopsy trajectories for an FPM assay in a patient with recurrent high-grade glioma. OBSERVATIONS A 25-year-old male with a history of recurrent high-grade glioma was scheduled for laser ablation and biopsy with ChemoID assaying after regions of potential recurrence were identified on follow-up imaging. Preoperative magnetic resonance (MR) spectroscopy of the regions showed areas of high choline/creatine ratios within lesions of radiation necrosis, which helped in planning the biopsy trajectories to selectively target malignancies for FPM analysis. ChemoID results showed high tumor susceptibility to lomustine, which was implemented as adjuvant therapy. LESSONS FPM therapy in the setting of recurrence is complicated by radiation necrosis, which can present as malignancy on imaging and interfere with tissue acquisition during biopsy or resection. Thus, operative approaches should be carefully planned with the assistance of imaging modalities such as MR spectroscopy to better ensure effective tissue acquisition for accurate FPM analysis and to promote more definitive treatment of recurrence.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Operative planning for a functional precision medicine assay of recurrent high-grade glioma: illustrative case

Mathews,

Shelton,

Horta

et al. 2024

Journal of Neurosurgery: Case Lessons

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show abstract

“…Conventional MRI has limited utility in differentiating between RIBN and tumor recurrence, requiring the use of different imaging modalities [ 13 ]. In particular, single-photon emission computed tomography, MR spectroscopy and MR perfusion-weighted imaging have demonstrated clinically meaningful advantages over conventional MRI, with sensitivity and specificity over 84% for all three modalities [ 13 ]. In our case, multiparametric MRI was used, which has been shown to increase performance over single-technique approaches [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

High-dose bevacizumab for radiation-induced brain necrosis: a case report

et al. 2023

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Radiation-induced brain necrosis (RIBN) is a common adverse event from radiation therapy. We present a case of a 56-year-old man, diagnosed with non-small-cell lung cancer with brain metastases 2 years prior, for which he had received whole brain radiotherapy and brain stereotactic radiosurgery, who presented to the oncology unit with headache, dizziness and abnormal gait. MRI of the brain revealed radiological worsening of a cerebellar mass, including edema and mass effect. After a multidisciplinary tumor board meeting, the patient was diagnosed with RIBN and received 4 cycles of high-dose bevacizumab, with complete symptom resolution and significant radiological response. We report the successful use of a high-dose, shorter-duration treatment protocol of bevacizumab for RIBN.

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“…In the early stages, traditional imaging of RN and tumor progression may demonstrate contrast enhancement on MRI, and large edema zones are usually observed around the lesions. In the long-term follow-up, RN indicated a decrease in tumor volume, while tumor progression indicated an increase in tumor volume ( 38 – 40 ). In these patients, the T2-weighted image margin ‘mismatched’ the contrast-enhanced T1-weighted image margin.…”

Section: Discussionmentioning

confidence: 99%

Radionecrosis mimicking pseudo‑progression in a patient with lung cancer and brain metastasis following the combination of anti‑PD‑1 therapy and stereotactic radiosurgery: A case report

Wang

Tan

et al. 2023

Oncol Lett

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Brain metastases (BMs) usually develop in patients with non-small cell lung cancer. In addition to systemic therapy, radiation therapy and surgery, anti-programmed cell death-ligand 1 (PD-L1) therapy is another promising clinical anticancer treatment modality. However, the optimal timing and drug-drug interactions of anti-PD-L1 therapy with other combined treatments remain to be elucidated. Treatment with anti-PD-L1 therapy is associated with an increased risk of radionecrosis (RN) regardless of tumor histology. The present study described a case of RN in a patient with lung adenocarcinoma and with BM who received anti-PD-L1 therapy. Before anti-PD-L1 treatment, the patient received whole brain radiotherapy. During durvalumab treatment, the intracranial metastases regressed. The progression of intracranial lesions 9 months later prompted a second-line of therapy with PD-L1 inhibitor durvalumab and stereotactic radiotherapy (SRT). Despite stereotactic irradiation, the lesions progressed further, leading to surgical resection. On examination, RN was detected, but there was no evidence of metastatic lung cancer. The aim of the present study was to present the longitudinal change in magnetic resonance imaging in RN following STR and anti-PD-L1 combined therapy. The atypical image of RN is conditionally important for making an accurate preoperative diagnosis.

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Differentiating radiation necrosis from tumor recurrence: a systematic review and diagnostic meta-analysis comparing imaging modalities

Cited by 9 publications

References 24 publications

Operative planning for a functional precision medicine assay of recurrent high-grade glioma: illustrative case

Operative planning for a functional precision medicine assay of recurrent high-grade glioma: illustrative case

High-dose bevacizumab for radiation-induced brain necrosis: a case report

Radionecrosis mimicking pseudo‑progression in a patient with lung cancer and brain metastasis following the combination of anti‑PD‑1 therapy and stereotactic radiosurgery: A case report

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