title: Radiation induced temporal lobe necrosis in patients with nasopharyngeal carcinoma: a review of new avenues in its management.
abstract: Temporal lobe necrosis (TLN) is the most debilitating late-stage complication after radiation therapy in patients with nasopharyngeal cancer (NPC). The bilateral temporal lobes are inevitably encompassed in the radiation field and are thus prone to radiation induced necrosis. The wide use of 3D conformal and intensity-modulated radiation therapy (IMRT) in the treatment of NPC has led to a dwindling incidence of TLN. Yet, it still holds great significance due to its incapacitating feature and the difficulties faced clinically and radiologically in distinguishing it from a malignancy. In this review, we highlight the evolution of different imaging modalities and therapeutic options. FDG PET, SPECT and Magnetic Spectroscopy are among the latest imaging tools that have been considered. In terms of treatment, Bevacizumab remains the latest promising breakthrough due to its ability to reverse the pathogenesis unlike conventional treatment options including large doses of steroids, anticoagulants, vitamins, hyperbaric oxygen and surgery.
authors.affiliation: Cancer Centre, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Chen
authors.forename: Meera
authors.initials: M
authors.lastname: Dassarath
authors.forename: Zhongyuan
authors.initials: Z
authors.lastname: Yin
authors.forename: Hongli
authors.initials: H
authors.lastname: Liu
authors.forename: Kunyu
authors.initials: K
authors.lastname: Yang
authors.forename: Gang
authors.initials: G
authors.lastname: Wu
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D000068258:Bevacizumab; D006801:Humans; D009682:Magnetic Resonance Spectroscopy / Q000379:methods; D009303:Nasopharyngeal Neoplasms / Q000150:complications / Q000532:radiotherapy*; D009336:Necrosis; D010100:Oxygen / Q000737:chemistry; D049268:Positron-Emission Tomography / Q000379:methods; D011832:Radiation Injuries / Q000175:diagnosis* / Q000628:therapy; D011878:Radiotherapy / Q000009:adverse effects*; D013256:Steroids / Q000627:therapeutic use; D013702:Temporal Lobe / Q000473:pathology* / Q000528:radiation effects*; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D016896:Treatment Outcome; D014815:Vitamins / Q000378:metabolism
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000925:Anticoagulants; D013256:Steroids; D014815:Vitamins; D000068258:Bevacizumab; D010100:Oxygen