Presentation
Radionecrosis of the brain presenting as a mass lesion: a case report. J Neurol Neurosurg Psychiatry. 1977 Aug;40(8):827–829. [PMC free article] [PubMed] [Google Scholar] Matsumura H, Ross ER. [ncbi.nlm.nih.gov]
We present a patient who developed cerebral radiation necrosis after protracted fluoroscopy during repeated embolisations of an extracranial arteriovenous malformation. [pn.bmj.com]
Similarly, Wong et al. described the therapeutic effect of bevacizumab in an NPC patient who presented with symptomatic temporal lobe necrosis following definitive radiotherapy (4). [atm.amegroups.com]
Entire Body System
- Pseudotumor
Late pseudotumoral brain necrosis following irradiation of a scalp neoplasm. Case report. J Neurosurg. 1976 Nov;45(5):581–584. [PubMed] [Google Scholar] Littman P, James H, Zimmerman R, Slater R. [ncbi.nlm.nih.gov]
Cardiovascular
- Hypertension
The nature of latent cerebral irradiation damage and its modification by hypertension. Br J Radiol. 1970 Mar;43(507):161–167. [PubMed] [Google Scholar] Sheline GE, Wara WM, Smith V. Therapeutic irradiation and brain injury. [ncbi.nlm.nih.gov]
- Thrombosis
There are numerous potential pathways to radiation necrosis which include: vascular injury acutely endothelial damage can lead to vasogenic edema chronically fibrosis, hyalinisation and stenosis can occur with eventual thrombosis and infarction vascular [radiopaedia.org]
Psychiatrical
- Suggestibility
The lack of FDG- and thallium-avid signals also suggests absence of malignancy or infection. [ascopubs.org]
It has been suggested that involvement of the corpus callosum with the crossing of the midline and multiple lesions or subependymal spread would favor a recurrent tumor over radiation necrosis 2, however, conventional imaging can be misleading, and no [radiopaedia.org]
In fact, from published reports, interpatient heterogeneity in bevacizumab radiological response for RN ranged from 25.5–63% (3,5,7,10,11) and a proportion of patients experienced a recurrence of their RN (5,7), suggesting that patient selection for this [atm.amegroups.com]
Neurologic
- Encephalopathy
Radiation encephalopathy--an autopsy case and some comments on the pathogenesis of delayed radionecrosis of central nervous system. Acta Pathol Jpn. 1973 Nov;23(4):867–883. [PubMed] [Google Scholar] Diengdoh JV, Booth AE. [ncbi.nlm.nih.gov]
- Focal Neurological Deficit
Thus, patients may be asymptomatic or may be symptomatic with focal neurological deficits, seizures, features of raised intracranial pressure, or cognitive impairment. [radiopaedia.org]
Treatment
Schmidt4, Lars-Henrik Krarup5 1 Department of Oncology, Rigshospitalet, København, Denmark 2 Department of Pathology, Rigshospitalet, København, Denmark 3 Department of Radiology, Rigshospitalet, København, Denmark 4 Department of Plastic Surgery and Burns Treatment [pn.bmj.com]
Conclusion: Symptoms are an indication of BVZ treatment for primary CRN. Keywords: Bevacizumab, cerebral radiation necrosis, clinical indication, drug usage, signs, symptoms. [benthamscience.com]
Although post-radiation treatment effects include pseudoprogression, which by definition is considered to be radiation treatment-related necrosis, particularly in the setting of concurrent chemotherapy for glioblastoma (Stupp protocol), this article focuses [radiopaedia.org]
Editorial Commentary Radiotherapy is an integral modality in the curative treatment of head and neck and nasopharynx cancers (NPCs) (1). [atm.amegroups.com]
Delayed cerebral radionecrosis following treatment of basal cell carcinoma. Arch Neurol. 1979 Jun;36(6):382–383. [PubMed] [Google Scholar] van Dellen JR, Danziger A. [ncbi.nlm.nih.gov]
Prognosis
[…] usually hypometabolic whereas tumor is hypermetabolic 18F-FET-PET Radiation necrosis has both lower mean and max uptake compared to normal brain parenchyma 7 tumor recurrence has an earlier peak uptake compared to radiation necrosis 7 Treatment and prognosis [radiopaedia.org]