title: Incidence and clinical course of radionecrosis in children with brain tumors. A 20-year longitudinal observational study.
abstract: Radionecrosis (RN) in children treated for brain tumors represents a potentially severe long-term complication. Its diagnosis is challenging, since magnetic resonance imaging (MRI) cannot clearly discriminate between RN and tumor recurrence. A retrospective single-center study was undertaken to describe the incidence and clinical course of RN in a cohort of 107 children treated with external radiotherapy (RT) for various brain tumors between 1992 and 2012. During a median follow-up of 4.6 years (range 0.29-20.1 years), RN was implied by suspicious MRI findings in in 5 children (4.7 %), 5-131 months after RT. Suspicion was confirmed histologically (1 patient) or substantiated by FDG positron-emission tomography (FDG-PET, 2 patients) or by FDG-PET and MR spectroscopy (1 patient). Before developing RN, all 5 patients had received cytotoxic chemotherapy in addition to RT. In addition to standard treatment protocols, 2 patients had received further chemotherapy for progression or relapse. Median radiation dose expressed as the biologically equivalent total dose applied in 2 Gy fractions (EQD2) was 51.7 Gy (range 51.0-60.0 Gy). At RN onset, 4 children presented with neurological symptoms. Treatment of RN included resection (n = 1), corticosteroids (n = 2) and a combination of corticosteroids, hyperbaric oxygen (HBO) and bevacizumab (n = 1). One patient with asymptomatic RN was not treated. Complete radiological regression of the lesions was observed in all patients. Clinical symptoms normalized in 3 patients, whereas 2 developed permanent severe neurological deficits. RN represents a severe long-term treatment complication in children with brain tumors. The spectrum of clinical presentation is wide; ranging from asymptomatic lesions to progressive neurological deterioration. FDG-PET and MR spectroscopy may be useful for distinguishing between RN and tumor recurrence. Treatment options in patients with symptomatic RN include conservative management (steroids, HBO, bevacizumab) and surgical resection.
authors: Division of Pediatric Hematology/Oncology, Medical University of Graz, Auenbruggerplatz 38, 8036, Graz, Austria. volker.strenger@medunigraz.at
authors: V
authors: V
authors: Strenger
authors: H
authors: H
authors: Lackner
authors: R
authors: R
authors: Mayer
authors: P
authors: P
authors: Sminia
authors: P
authors: P
authors: Sovinz
authors: M
authors: M
authors: Mokry
authors: A
authors: A
authors: Pilhatsch
authors: M
authors: M
authors: Benesch
authors: W
authors: W
authors: Schwinger
authors: M
authors: M
authors: Seidel
authors: D
authors: D
authors: Sperl
authors: S
authors: S
authors: Schmidt
authors: C
authors: C
authors: Urban
mesh_terms: D000293:Adolescent; D001317:Austria / Q000453:epidemiology; D001930:Brain Injuries / Q000453:epidemiology*; D001932:Brain Neoplasms / Q000453:epidemiology* / Q000532:radiotherapy*; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D011832:Radiation Injuries / Q000453:epidemiology*; D020266:Radiotherapy, Conformal / Q000706:statistics & numerical data*; D018570:Risk Assessment; D016896:Treatment Outcome; D055815:Young Adult
references: Lancet Oncol. 2008 May;9(5):453-61
references: 18452856
references: Int J Radiat Oncol Biol Phys. 2009 Jan 1;73(1):214-21
references: 18485616
references: Cancer. 1997 Nov 15;80(10):2005-12
references: 9366305
references: Strahlenther Onkol. 2001 Sep;177(9):447-61
references: 11591018
references: Int J Radiat Oncol Biol Phys. 1982 Nov;8(11):1981-97
references: 6759484
references: Strahlenther Onkol. 2008 May;184(5):276-80
references: 18427759
references: Int J Cancer. 2001 Jun 20;96(3):191-7
references: 11410888
references: Cancer. 1996 Jun 1;77(11):2407-12
references: 8635114
references: J Clin Oncol. 2002 Feb 1;20(3):842-9
references: 11821469
references: J Clin Oncol. 2004 Nov 15;22(22):4551-60
references: 15542806
references: Klin Padiatr. 2007 May-Jun;219(3):139-45
references: 17525907
references: Int J Radiat Oncol Biol Phys. 2011 Apr 1;79(5):1487-95
references: 20399573
references: Radiographics. 1996 Sep;16(5):1055-72
references: 8888390
references: Int J Radiat Oncol Biol Phys. 2006 Jun 1;65(2):499-508
references: 16517093
references: Strahlenther Onkol. 2012 Jan;188(1):91-2; author reply 92-3
references: 22194026
references: Strahlenther Onkol. 2011 Dec;187(12):784-91
references: 22105769
references: Strahlenther Onkol. 2005 Feb;181(2):113-23
references: 15702300
references: Med Pediatr Oncol. 1987;15(5):241-53
references: 3309606
references: Neuro Oncol. 2008 Jun;10(3):361-7
references: 18401015
references: Int J Radiat Oncol Biol Phys. 2008 Apr 1;70(5):1350-60
references: 18037587
references: Radiology. 2000 Nov;217(2):377-84
references: 11058631
references: Neuropediatrics. 2005 Apr;36(2):71-7
references: 15822019
references: Cancers (Basel). 2012 Apr 05;4(2):379-99
references: 24213316
references: Cancer. 1996 Aug 15;78(4):864-73
references: 8756383
references: J Neurooncol. 2006 Jun;78(2):199-205
references: 16739030
references: Childs Nerv Syst. 2001 Dec;17(12):731-8
references: 11862439