title: Impact of Resecting Radiation Necrosis and Pseudoprogression on Survival of Patients with Glioblastoma.
abstract: BACKGROUND
  Radiation necrosis (RN) and pseudoprogression are known as postradiation treatment effects and may simulate tumor progression. The disease course of glioblastoma patients who had developed RN and the impact of resecting RN on survival have not been evaluated. This study examines the clinical course of patients considered candidates for repeat surgery for a recurring brain mass proven to be RN and compared these with patients who had true tumor recurrence at surgery.
  
  
  METHODS
  Of 159 patients with glioblastoma who were reoperated on because of a presumed recurrent tumor requiring repeat surgery, 18 had RN as the major component of the resected mass. The characteristics and outcome of these 18 patients were retrospectively analyzed and compared with patients in whom active and bulky tumor was found during surgery.
  
  
  RESULTS
  Radiation necrosis occurred significantly earlier than true tumor recurrence. Patients with RN harbored larger lesions and were significantly more symptomatic before the second surgery. Most patients with RN who underwent GTR of the lesion in the second operation experienced faster resolution of the surrounding edema compared with patients who underwent STR or biopsy only. There was no significant difference in survival between the 2 groups.
  
  
  CONCLUSIONS
  These data provide an opportunity to examine the clinical course of a selected group of patients with histologically verified RN. Although RN is associated with more severe neurologic symptoms that improve after surgery, its occurrence or surgical removal carries no survival advantage compared with patients who undergo a repeat operation for true tumor recurrence.
authors.affiliation: Department of Neurosurgery, Tel Aviv Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. Electronic address: rachelgr@tasmc.health.gov.il.
authors.forename: Rachel
authors.initials: R
authors.lastname: Grossman
authors.affiliation: Department of Neurosurgery, Tel Aviv Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Nir
authors.initials: N
authors.lastname: Shimony
authors.affiliation: Department of Neurosurgery, Tel Aviv Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Uri
authors.initials: U
authors.lastname: Hadelsberg
authors.affiliation: Department of Pathology, Tel Aviv Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Dov
authors.initials: D
authors.lastname: Soffer
authors.affiliation: Department of Neurosurgery, Tel Aviv Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Razi
authors.initials: R
authors.lastname: Sitt
authors.affiliation: Institute of Radiotherapy, Tel Aviv Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Natan
authors.initials: N
authors.lastname: Strauss
authors.affiliation: Institute of Radiotherapy, Tel Aviv Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Benjamin W
authors.initials: BW
authors.lastname: Corn
authors.affiliation: Department of Neurosurgery, Tel Aviv Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Zvi
authors.initials: Z
authors.lastname: Ram
mesh_terms: D001929:Brain Edema / Q000209:etiology / Q000473:pathology; D001932:Brain Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects*; D005260:Female; D005909:Glioblastoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery; D011832:Radiation Injuries / Q000209:etiology* / Q000473:pathology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D017211:Treatment Failure
keywords: Craniotomy; Glioma; Outcome; Pseudoprogression; Radiation necrosis