Department of Neurological Surgery, George Washington University Medical Center, Washington, DC, USA.
Acta Neurochir (Wien). 2012 Feb;154(2):191-201; discussion 201. doi: 10.1007/s00701-011-1228-6. Epub 2011 Dec 1.
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.
放射治疗是恶性胶质瘤标准治疗方案的一个组成部分，在随机对照试验中已被证明具有疗效。然而，放射治疗并非没有风险，在一定比例的患者中会发生放射损伤。复发与放射损伤的鉴别困难使治疗过程复杂化，并可能影响治疗效果。最近区分了两种类型的放射损伤：假性进展和放射性坏死，这可能分别是肿瘤和正常组织受到放射损伤的结果。深入了解放射诱导损伤为进一步治疗提供了指导。我们详细介绍了目前对放射损伤机制的认识，以及潜在的治疗靶点。此外，还描述了各种诊断方法，以及在其病理生理学和临床疗效的背景下的多种治疗选择。放射治疗是胶质瘤多学科管理的一个组成部分，最佳的放射损伤诊断和管理对于改善患者预后至关重要。
