Results of excision of cerebral radionecrosis: experience in patients treated with radiation therapy for nasopharyngeal carcinoma

Wong, Sui-To; Loo, K. T.; Yam, Kwong-Yui; Hung, Wai-Man; Fok, Kam-Fuk; Yuen, Shing-Chau; Fong, Dawson

doi:10.3171/2010.1.jns091039

Cited by 18 publications

(9 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The prognosis of RITN after surgery is favorable. Resection of necrotic lesions not only immediately relieves the potentially life-threatening increased intracranial pressure, but also is likely to be effective in promptly controlling brain edema and attenuating the progression of necrosis by removing its inflammatory components [16]. …”

Section: Discussionmentioning

confidence: 99%

Neurosurgical interventions for patients with nasopharyngeal carcinoma: a single institution experience

et al. 2013

View full text Add to dashboard Cite

BackgroundNasopharyngeal carcinoma (NPC) is a frequent head and neck cancer in southern China and Southeast Asia. The majority of NPC patients are managed by radiation oncologists, medical oncologists and head and neck surgeons. Actually, neurosurgical interventions are warranted under specific circumstances. In this article, we described our experience as neurosurgeons in the management of NPC patients.MethodsMedical records of NPC patients who received neurosurgical procedure at Sun Yat-sen University Cancer Center were reviewed.ResultsTwenty-seven patients were identified. Among 27 cases, neurosurgical procedures were performed in 18 (66.7%) with radiation-induced temporal necrosis, 2 (7.4%) with radiation-induced sarcoma, 4 (14.8%) with synchronous NPC with primary brain tumors, 2 (7.4%) with recurrent NPC involving skull base, and 1 (3.7%) with metachronous skull eosinophilic granuloma, respectively. The diagnosis is challenging in specific cases and initial misdiagnoses were found in 6 (22.2%) patients.ConclusionsFor NPC patients with intracranial or skull lesions, the initial diagnosis can be occasionally difficult because of the presence or a history of NPC and related treatment. Unawareness of these entities can result in misdiagnosis and subsequent improper treatment. Neurosurgical interventions are necessary for the diagnosis and treatment for these patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Neurosurgical interventions for patients with nasopharyngeal carcinoma: a single institution experience

et al. 2013

View full text Add to dashboard Cite

show abstract

“…The findings are maculopathy and/or necrosis [4], but some of these are not due to radiation itself, but due to the mass effect of these lesions over the brain [5]. Among symptoms we can see cognitive deficits, hemiparesis, aphasia, seizures and any another depending on the cerebral topography, with tumor-like symptoms [6,7].…”

Section: Discussionmentioning

confidence: 99%

“…Surgery was always the last option on radionecrosis treatment, indicated only in large lesions, hemorrhagic complications or brain abscess [5,8,9]. Necrotic tissue resection along with decompressive craniectomy seems to improve prognosis of these patients, especially for those in emergency situations [10].…”

Section: Discussionmentioning

confidence: 99%

“…The treatment goals on radionecrosis, being a non-neoplastic condition, must be minimizing loss of neurological function, preventing progression and, if possible, reverting the pathological process [5]. Traditional treatment includes corticosteroids, antiplatelets, anticoagulants, high doses of vitamins and surgery [1,2,5,6,9,10].…”

Section: Discussionmentioning

confidence: 99%

“…Traditional treatment includes corticosteroids, antiplatelets, anticoagulants, high doses of vitamins and surgery [1,2,5,6,9,10].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Brain Radionecrosis: Case Report

Almeida¹,

Nascimento²,

Rogério³

et al. 2016

J Neurol Res

View full text Add to dashboard Cite

Brain necrosis is a possible complication caused by radiation therapy used in the treatment of head and neck cancer. This complication has variable neurological symptoms according to the site of brain damage, including motor deficits, aphasia, altered consciousness, seizures, and intracranial hypertension and also a variable time for presentation ranging from 3 months to 10 years. Once established, brain injury is irreversible and it is characterized by non-specific radiological image that submits the questions about its etiology: is it secondary to radionecrosis? Tumor progression? Primary tumor? The clinical report here described demonstrates the possibility of such differential diagnosis in a patient with brain lesion as a consequence of radiotherapy for a skin cancer.

show abstract

Interventions for the treatment of brain radionecrosis after radiotherapy or radiosurgery

Chung

Bryant

Brown

2018

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

There is a lack of good certainty evidence to help quantify the risks and benefits of interventions for the treatment of brain radionecrosis after radiotherapy or radiosurgery. In an RCT of 14 patients, bevacizumab showed radiological response which was associated with minimal improvement in cognition or symptom severity. Although it was a randomised trial by design, the small sample size limits the quality of data. A trial of edaravone plus corticosteroids versus corticosteroids alone reported greater reduction in the surrounding oedema with combination treatment but no effect on the enhancing radionecrosis lesion. Due to the open-label design and wide confidence intervals in the results, the quality of this data was also low. There was no evidence to support any non-pharmacological interventions for the treatment of radionecrosis. Further prospective randomised studies of pharmacological and non-pharmacological interventions are needed to generate stronger evidence. Two ongoing RCTs, one evaluating bevacizumab and one evaluating hyperbaric oxygen therapy were identified.

show abstract

Results of excision of cerebral radionecrosis: experience in patients treated with radiation therapy for nasopharyngeal carcinoma

Cited by 18 publications

References 20 publications

Neurosurgical interventions for patients with nasopharyngeal carcinoma: a single institution experience

Neurosurgical interventions for patients with nasopharyngeal carcinoma: a single institution experience

Brain Radionecrosis: Case Report

Interventions for the treatment of brain radionecrosis after radiotherapy or radiosurgery

Contact Info

Product

Resources

About