Radiation induced temporal lobe necrosis in patients with nasopharyngeal carcinoma: a review of new avenues in its management

Chen, Jing; Dassarath, Meera; Yin, Zhongyuan; Liu, Hongli; Yang, Kunyu; Wu, Gang

doi:10.1186/1748-717x-6-128

Cited by 74 publications

(66 citation statements)

References 62 publications

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“…Long-term therapy is often necessary to provide symptomatic control, which may result in immunosuppression, myopathy, psychiatric disturbances, osteopenia, glucose intolerance, abnormal fat distribution, or poor wound healing. Recent treatment of post-radiation necrosis was introduced by bevacizumab, as an angiogenesis inhibitor, which a drug was inhibiting vascular endothelial growth factor A [5,22]. Usual dosages of bevacizumab are a dose of 5 mg/kg every 2 weeks or 7.5 mg/kg every 3 weeks.…”

Section: Discussionmentioning

confidence: 99%

“…Most cases are related with cancer and got therapeutic RT. Nasopharyngeal carcinoma, usually treated with RT, were reported by several late complications, and infrequently reported for brain necrosis [3][4][5]. Thus, for physiatrists, post-radiation brain necrosis is a cause of burdens for disabilities.…”

Section: Introductionmentioning

confidence: 99%

“…The clinical and radiographic changes generally improve over a few months [6]. necrosis can occur after treatment of primary or metastatic brain tumors, or following incidental irradiation of the brain during treatment of extraneural tumors such as pituitary adenoma, nasopharyngeal carcinoma [5,7]. Diffuse cerebral injury is most frequent form of post-radiation brain injury and can cause neuro-cognitive deficit [8,9].…”

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confidence: 99%

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Pontine Necrosis Related with Radiation Therapy, Complicated with Spontaneous Hemorrhage

et al. 2017

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Highlights• Radiation therapy (RT) is frequently used. for treatment of head and neck cancer.• RT might induce vascular injury, such as telangiectasia and endothelial cell injury.• These vascular injuries may result in spontaneous hemorrhage in necrotic brain.• Physicians should be aware of complication, as brain necrosis with hemorrhage. ABSTRACTThe brain necrosis induced by radiation therapy (RT) is an uncommon pathology of brain. A case of spontaneous hemorrhage at necrotic brain is also rare. A 52-year-old man who had nasopharyngeal carcinoma and had been treated with RT, presented with gait disturbance, dizziness, ataxia, dysarthria, and dysphagia. Magnetic resonance imaging (MRI) demonstrated progressed radiation necrosis of pons, and spontaneous hemorrhage at the site of necrosis. The hematoma was diminished by conservative treatment. However, the patient's neurologic symptoms did not recover. Two years later, spontaneous bleeding recurred at necrotic brain. His neurologic symptoms worsened. One year later, his neurologic symptoms were more progressed. He showed severe dysphagia, profound weakness and respiratory failure. This case provides the description of relapsed spontaneous hemorrhage and medullary dysfunction caused by pontine necrosis and progressed post-radiation injury, complicated with hemorrhage, and urges caution in that the necrotic brain tissue may be vulnerable to bleeding. Keywords: Radiation Necrosis; Radiation Therapy; Pontine Hemorrhage INTRODUCTIONThe brain necrosis is an infrequent late complication related with radiation therapy (RT), and usually induces progressive and irreversible process, and requires medical or surgical treatment [1,2]. Most cases are related with cancer and got therapeutic RT. Nasopharyngeal carcinoma, usually treated with RT, were reported by several late complications, and infrequently reported for brain necrosis [3][4][5]. Thus, for physiatrists, post-radiation brain necrosis is a cause of burdens for disabilities.In this case report, we describe a patient with pontine demyelination and necrosis, who had been treated with RT for nasopharyngeal carcinoma. Spontaneous bleeding occurred after necrosis, twice. The recovery of patient was significantly impaired and showed poor Conflict of InterestThe authors have no potential conflicts of interest to disclose. Ha Min CASE REPORTA 52-year-old man was presented with gait disturbance, dizziness, ataxia, dysarthria, and progressed dysphagia in December 2009. The patient had nasopharyngeal carcinoma, stage IV (T4N2M0) involving sphenoid, infratemporal fossa and skull base and was treated with radiation therapy (RT, total dose of irradiation 85GY) and chemotherapy for 2 years ago. After treatment, his cancer was diminished as clinical remission. Magnetic resonance imaging (MRI) showed contrast enhancing lesion with edema (Fig. 1). The lesion was revealed as postradiation brain injury by magnetic resonance (MR) spectroscopy, for differential diagnosis from metastatic cancer (Fig. 1). And then he got steroid therapy f...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Pontine Necrosis Related with Radiation Therapy, Complicated with Spontaneous Hemorrhage

et al. 2017

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“…In particular, , 2D dose distribution technique in the radiation therapy treatment induces temporal lobe necrosis (TLN) hence becomes a common late damage that adversely affects the quality of life (14) . However, the hearing loss and facial weakness is a function of cranial nerve damage due to radiation dose escalation to the surrounding tissues (15) . Nevertheless, temporal lobe contains rich networks of other sensitive structures that are at risk after radiotherapy and that may contribute to toxicity afterward.…”

Section: Iii1 Temporal Lobementioning

confidence: 99%

The Advantages of Two Dimensional Techniques (2D) in Pituitary Adenoma Treatment

Adama¹,

Gar-elnabi²,

AliOmer³

2014

IOSRJAP

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“…and extra-axial tumors 5,7,8 . Its incidence after conventional radiation therapy ranges from 5% to 24% 9,10 .…”

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Radiologic Patterns of Necrosis After Proton Therapy of Skull Base Tumors

Korchi

Garibotto

Lövblad

et al. 2013

Can. J. Neurol. Sci.

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Proton beam therapy (PBT) is used for the treatment of skull base tumors to precisely deliver high-doses of radiation to the tumor volume while sparing normal brain tissue and other organs at risk such as the optic apparatus, the brainstem and the pituitary gland. It offers superior dose distribution as compared to photon radiation therapy. The clinical advantage of PBT over photon techniques is the marked reduction in the integral dose to the patient due to the absence of an exit dose beyond the proton Bragg peak. Proton beam therapy has shown benefits in the treatment of skull base tumors, uveal melanoma, optic pathway gliomas, pituitary adenomas, acoustic neuromas, nasopharynx and paranasal sinus tumors and spinal cord tumors. [1][2][3][4] . A rare yet important complication following brain radiation therapy is radiation necrosis 5-7 , i.e. the appearance of a new ABSTRACT: Background: Discrimination between radiation necrosis and tumor progression after radiation therapy represents a radiologic challenge. The aim of our investigation is to identify patterns of radiation necrosis on brain magnetic resonance imaging (MRI) and positron emission tomography (PET) with Fluoroethyltyrosin (FET) after proton beam therapy (PBT) for skull base tumors. Material and Methods:Five consecutive patients with extra-axial neoplasms were included, presenting a total of eight radiation necrosis lesions (three clival chordomas; two petroclival chondrosarcomas; two women; mean age: 49 ± 18.2 years). Radiation necrosis was defined as the appearance of abnormal enhancement on MRI after PBT decreasing over time, and additional histopathologic confirmation in one patient. MRI and PET imaging were retrospectively analyzed by two experienced radiologists in consensus. Results: All lesions were localized close to the primary tumor in the field of irradiation. Three patients showed bilateral symmetrical lesions. All lesions showed T2 hyperintensity and T1 hypointensity. Cerebral blood volume (CBV) was reduced in all available studies. None of the lesions showed a restricted diffusion. FET-PET (three patients) showed a higher uptake in four out of five lesions; three of which had a mean tumor-to-background (TBRmean) uptake lower than 1.95 and FET uptake increasing over time and were correctly classified into radiation necrosis. Conclusions: Most radiation necroses were in direct continuity with the primary tumor mimicking tumor progression. The most consistent imaging findings for PBT radiation necrosis are low CBV without restricted diffusion and FET-PET TBRmean lower than 1.95 or increasing uptake over time. Bilateral symmetric involvement may be another indicator of radiation necrosis.RÉSUMÉ: Critères radiologiques de la nécrose après protonthérapie des tumeurs de la base du crâne. Contexte : La distinction entre la nécrose due à l'irradiation et la progression de la tumeur après l'irradiation est un défi au point de vue radiologique. Le but de notre étude était d'identifier le profil radiologique de la nécrose radio-induite à l'IRM et...

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Radiation induced temporal lobe necrosis in patients with nasopharyngeal carcinoma: a review of new avenues in its management

Cited by 74 publications

References 62 publications

Pontine Necrosis Related with Radiation Therapy, Complicated with Spontaneous Hemorrhage

Pontine Necrosis Related with Radiation Therapy, Complicated with Spontaneous Hemorrhage

The Advantages of Two Dimensional Techniques (2D) in Pituitary Adenoma Treatment

Radiologic Patterns of Necrosis After Proton Therapy of Skull Base Tumors

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