title: The diagnosis and treatment of pseudoprogression, radiation necrosis and brain tumor recurrence.
abstract: Radiation therapy is an important modality used in the treatment of patients with brain metastatic disease and malignant gliomas. Post-treatment surveillance often involves serial magnetic resonance imaging. A challenge faced by clinicians is in the diagnosis and management of a suspicious gadolinium-enhancing lesion found on imaging. The suspicious lesion may represent post-treatment radiation effects (PTRE) such as pseudoprogression, radiation necrosis or tumor recurrence. Significant progress has been made in diagnostic imaging modalities to assist in differentiating these entities. Surgical and medical interventions have also been developed to treat PTRE. In this review, we discuss the pathophysiology, clinical presentation, diagnostic imaging modalities and provide an algorithm for the management of pseudoprogression, radiation necrosis and tumor recurrence.
authors.affiliation: Division of Neurosurgery, University Health Network, Toronto Western Hospital, University of Toronto, Toronto, ON M5T 2S8, Canada. kashif.parvez@utoronto.ca.
authors.forename: Kashif
authors.initials: K
authors.lastname: Parvez
authors.affiliation: Department of Medical Imaging, Royal University Hospital, University of Saskatchewan, Saskatoon, SK S7N 0W8, Canada. aparvez@ucalgary.ca.
authors.forename: Aatif
authors.initials: A
authors.lastname: Parvez
authors.affiliation: Division of Neurosurgery, University Health Network, Toronto Western Hospital, University of Toronto, Toronto, ON M5T 2S8, Canada. Gelareh.Zadeh@uhn.ca.
authors.forename: Gelareh
authors.initials: G
authors.lastname: Zadeh
mesh_terms: D001932:Brain Neoplasms / Q000175:diagnosis* / Q000532:radiotherapy; D003937:Diagnosis, Differential; D005910:Glioma / Q000175:diagnosis* / Q000532:radiotherapy; D006801:Humans; D011832:Radiation Injuries / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D011878:Radiotherapy / Q000009:adverse effects; D012008:Recurrence