[Delayed cerebral radionecrosis following radiation therapy of cutaneous squamous cell carcinomas of the head].
BACKGROUND
Three cases of cerebral radionecrosis occurring after radiation therapy for squamous cell carcinomas of the scalp are reported. This rare and poorly documented complication of radiotherapy is discussed.


METHODS
Three patients presenting with squamous cell carcinomas of the scalp were treated with surgery and radiotherapy for recurrent or incomplete resection of squamous cell carcinomas of the head. X-ray doses range were 50 to 60 Grays in 22 to 24 fractions. Cerebral radionecrotic lesions were diagnosed 6 months to 14 years after irradiation, and were inconstantly associated with clinical symptoms. The patients were treated with systemic steroids, which were of limited efficacy in one of our patients.


CONCLUSIONS
Little is known of cerebral radionecrosis following radiotherapy. This may be related to their rare occurrence and/or to the difficulties in establishing diagnosis. The delay of occurrence after radiotherapy can vary between a few months and several years, and the lesions are directly correlated with the doses and the fractionning of the X-rays. Intracerebral localization of the tumour is the main differential diagnosis. Localized and cystic forms of cerebral radionecrosis can be treated by surgery. Treatment otherwise relies on systemic steroids.
Kerob
D
D
Service de Dermatologie, Institut Gustave Roussy, 39, rue Camille Desmoulins, 94805 Villejuif.
Kolb
F
F
Margulis
A
A
Mamelle
G
G
Spatz
A
A
Ibrahim
M
M
Avril
M F
MF
D000368:Aged; D001921:Brain / Q000473:pathology / Q000528:radiation effects*; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy*; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D011832:Radiation Injuries / Q000175:diagnosis* / Q000473:pathology; D011879:Radiotherapy Dosage; D012535:Scalp / Q000528:radiation effects; D012878:Skin Neoplasms / Q000532:radiotherapy*
Radionécroses cérébrales tardives après traitement par radiothérapie de carcinomes épidermoïdes cutanés de la tête.