The Risk of Cerebral Radionecrosis in Relation to Dose, Time and Fractionation

Marks, Joe; Wong, J.K.

doi:10.1159/000411642

Cited by 104 publications

(47 citation statements)

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“…These late complications for RT usually occur in several months to several years after RT [13]. The incidence of late brain injury would increase with increment of total dose of radiation, especially more than total dose of 54 Gy, or fractions of 2 Gy/day [14,15]. The higher total doses (85 Gy) might be main causative factor in this case.…”

Section: Discussionmentioning

confidence: 83%

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: 83%

Pontine Necrosis Related with Radiation Therapy, Complicated with Spontaneous Hemorrhage

et al. 2017

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“…2) Clinical reports also suggest that larger total doses of radiation are associated with earlier onset of delayed necrosis. 16) Patients with nasopharyngeal carcinoma who received a higher fractional dose had a significantly higher incidence of temporal lobe necrosis than those treated with a higher total dose but a lower fractional dose, suggesting that the fractional dose is the most significant factor affecting cerebral radionecrosis. 11) In our case, the total dosage of 80 Gy was not expected to cause radionecrosis.…”

Section: Discussionmentioning

confidence: 95%

Late Bilateral Temporal Lobe Necrosis After Conventional Radiotherapy-Case Report-

Hoshi

Hayashi

Kono

et al. 2003

Neurol. Med. Chir.(Tokyo)

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A 63-year-old woman presented with radionecrosis in the bilateral temporal lobes manifesting as dementia about 30 years after undergoing conventional radiotherapy for pituitary adenoma. Computed tomography and magnetic resonance (MR) imaging showed edema and cystic lesions in both temporal lobes. The mass in the left temporal lobe was excised. MR imaging 12 days after surgery showed reduced edema. Her dementia had improved. Radionecrosis usually occurs between several months and a few years after radiotherapy. The incidence of radionecrosis is estimated as 5%, but may be higher with longer follow-up periods. Clinical reports have suggested that larger total doses of radiation are associated with earlier onset of delayed necrosis and the fractional dose is the most significant factor causing cerebral radionecrosis. Radionecrosis can occur long after conventional radiotherapy or stereotactic radiosurgery using a linac-based system or a gamma knife unit.

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“…Radiotherapy -in the form of external beam radiation, brachytherapy, or stereotactic radiotherapy-consists the primary adjuvant treatment after surgical resection. Among the delayed side effects of radiation therapy, radionecrosis is the most prominent, primarily depending on the administered dose and rate of delivery and usually occurs within 6 months to 2 years, the same period during which disease recurrence is also rather frequent (Marks & Wong, 1985).…”

Section: Discriminating Recurrent Disease From Radiation Necrosis In mentioning

confidence: 99%

Metabolic Imaging of Brain Tumor by 99mTc-Tetrofosmin Scintitomography

Tsiouris¹,

Alexiou²,

Παπαδόπουλος³

et al. 2011

Diagnostic Techniques and Surgical Management of Brain Tumors

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The Risk of Cerebral Radionecrosis in Relation to Dose, Time and Fractionation

Cited by 104 publications

References 0 publications

Pontine Necrosis Related with Radiation Therapy, Complicated with Spontaneous Hemorrhage

Pontine Necrosis Related with Radiation Therapy, Complicated with Spontaneous Hemorrhage

Late Bilateral Temporal Lobe Necrosis After Conventional Radiotherapy-Case Report-

Metabolic Imaging of Brain Tumor by 99mTc-Tetrofosmin Scintitomography

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