title: Radiation necrosis following treatment of high grade glioma--a review of the literature and current understanding.
abstract: Radiation therapy is an integral part of the standard treatment paradigm for malignant gliomas, with proven efficacy in randomized control trials. Radiation treatment is not without risk however, and radiation injury occurs in a certain proportion of patients. Difficulties in differentiating recurrence from radiation injury complicate the treatment course and can compromise care. These complexities are compounded by the recent distinction of two types of radiation injury: pseudoprogression and radiation necrosis, which are likely the result of radiation injury to the tumor and normal tissue, respectively. A thorough understanding of radiation-induced injury offers insights to guide further therapies. We detail the current knowledge of the mechanisms of radiation injury, along with potential targets for therapeutic intervention. Various diagnostic modalities are also described, in addition to the multiple options for treatment within the context of their pathophysiology and clinical efficacy. Radiation therapy is an integral part of the multidisciplinary management of gliomas, and the optimal diagnosis and management of radiation injury is paramount to improving patient outcomes.
authors: Department of Neurological Surgery, George Washington University Medical Center, Washington, DC, USA.
authors: Alan
authors: A
authors: Siu
authors: Joshua J
authors: JJ
authors: Wind
authors: J Bryan
authors: JB
authors: Iorgulescu
authors: Timothy A
authors: TA
authors: Chan
authors: Yoshiya
authors: Y
authors: Yamada
authors: Jonathan H
authors: JH
authors: Sherman
mesh_terms: D001921:Brain / Q000473:pathology*; D001932:Brain Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects; D004730:Endothelium, Vascular / Q000473:pathology; D005909:Glioblastoma / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D009186:Myelin Sheath / Q000473:pathology; D009336:Necrosis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000473:pathology*; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects*