Therapeutic strategy of late cerebral radionecrosis. A retrospective study of 21 cases.
OBJECTIVE
Late cerebral radiation necrosis (LCR) is a serious complication of radiation treatment for brain tumors. This study investigates the diagnosis and management of patients with late clinical and neuroradiological cerebral radionecrosis after primary removal of brain neoplasm. The authors discuss the clinical features and long-term outcome of 21 patients with late cerebral radionecrosis and emphasize the importance of surgical and medical therapy.


METHODS
Twenty-one patients with brain tumor treated by surgical resection or brain biopsy alone after radiotherapy during follow-up developed radionecrosis. The magnetic resonance imaging (MRI), surgical and clinical findings of these patients with radionecrosis are reviewed.


RESULTS
MRI showed radionecrosis in 21 patients, 9 of which had undergone craniotomy for lesion removal.


CONCLUSIONS
Late radionecrosis is infrequent following radiation therapy and may simulate tumor recurrence on MRI scans. From the authors' experience it is evident that, once begun, radiation treatment of neoplastic lesions can lead to complications such as late cerebral radionecrosis which often require surgical treatment. As correct diagnosis is necessary for appropriate treatment, a fair balance needs to be struck when considering ionizing radiation, medical therapy, surgery and diagnostic imaging.
Carangelo
B
B
Department of Neurosurgery, University of Siena, Siena, Italy. biagiorobicarangelo@gmail.com
Cerillo
A
A
Mariottini
A
A
Peri
G
G
Rubino
G
G
Mourmouras
V
V
Palma
L
L
D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D001932:Brain Neoplasms / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery; D003399:Craniotomy; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009381:Neoplasms, Radiation-Induced / Q000473:pathology* / Q000601:surgery; D011184:Postoperative Period; D011832:Radiation Injuries / Q000473:pathology*; D011878:Radiotherapy / Q000009:adverse effects*