[Brain radionecrosis in patients irradiated for nasopharyngeal carcinoma: about nine cases].
OBJECTIVE
To study the clinical, radiological, therapeutic and progressive aspects of brain radionecrosis after treatment for nasopharyngeal carcinoma.


METHODS
Nine patients (seven men and two women) of mean age 47.7 years old (extremes: 18-57 years old) were treated for UCNT (undifferentiated carcinoma of the nasopharynx) between 1989 and 2003 and developed cerebral radionecrosis. All patients were treated with radical radiotherapy. The mean total dose was 73.5 Gy (70-75 Gy). Dose per fraction was 2 to 2.5 Gy, one fraction daily. One patient received adjuvant brachytherapy to the dose of 8 Gy and four patients also received chemotherapy.


RESULTS
Brain radionecrosis was authenticated by brain imaging (CT scan+/-MRI): the imaging was ordered in seven cases to elucidate non-specific neurological signs and two cases were discovered fortuitously. The time to the appearance of neurological signs was 40.3 months (10 to 108 months). The localization was temporal in six cases, parieto-occipital (one case) and bulbomedullar (two cases). After a mean follow-up period of 30.6 months (12-84 months), clinical outcomes were favorable in all cases receiving medical treatment (corticoids), with a stabilization of the radiological lesions in eight cases and complete radiological regression in one patient.


CONCLUSIONS
Brain radionecrosis is a late complication rarely occurring in patients irradiated for UCNT. Imaging techniques (CT scan but more so MRI) play a major role in the diagnosis. Corticotherapy resulted in a durable objective response in all patients and, in most cases, resulted in radiological stabilization.
Nasr Ben Ammar
C
C
Service de carcinologie-radiothérapie, institut Salah-Azaiz, Tunis, Tunisie. chiraz_ammar@yahoo.fr
Chaari
N
N
Kochbati
L
L
Attia
I
I
Ben Hamadi
D
D
Chebbi
A
A
Saadi
A
A
Besbes
M
M
Maalej
M
M
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000367:Age Factors; D000700:Analgesics / Q000627:therapeutic use; D001812:Blood-Brain Barrier; D001918:Brachytherapy; D001921:Brain / Q000473:pathology*; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D009305:Nasopharynx / Q000473:pathology; D009336:Necrosis; D009367:Neoplasm Staging; D011832:Radiation Injuries / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology / Q000473:pathology*; D011878:Radiotherapy / Q000009:adverse effects*; D011879:Radiotherapy Dosage; D012074:Remission Induction; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed
D000305:Adrenal Cortex Hormones; D000700:Analgesics