2018 Volume 25 Issue 1 Pages 23-32
Authors reviewed brain radiation necrosis after cranial irradiation for brain tumors, including pathophysiology, diagnosis, and treatment. Inflammation and angiogenesis were associated with the formation of radiation necrosis. Vascular endothelial growth factor, platelet-derived growth factor, and CXCL12 were overexpressed around the necrotic core. Radiological diagnosis is sometimes difficult to distinguish brain radiation necrosis from tumor recurrence. Chemical and perfusion images are helpful to differentiate these two pathologies.
Nuclear medicine images also help us clinically diagnosis radiation necrosis. Corticosteroids are useful to reduce brain edema and improve patient symptoms. In cases with progressive radiation necrosis, corticosteroids are no longer effective and surgical removal of necrosis is used to be required. Recently, bevacizumab was reported to markedly reduced brain edema and improve neurological symptoms and could be a novel treatment for brain radiation necrosis.