Munier Sean, Ginalis Elizabeth E, Patel Nitesh V, Danish Shabbar, Hanft Simon
Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA.
Neurosurgery, Rutgers Robert Wood Johnson Medical School, Piscataway, USA.
Cureus. 2020 Apr 9;12(4):e7603. doi: 10.7759/cureus.7603.
Radiation necrosis (RN) is a challenging potential complication of cranial radiation therapy. Believed to result from a complex interplay of vascular, glial, and immunologic factors, the exact mechanism of RN remains unclear. Patients who develop RN typically have a history of treatment with stereotactic radiation surgery or some other form of radiation-based therapy. The time frame for its development is variable, but it most often occurs one to three years following radiation therapy. Reported treatment doses capable of inducing radiation necrosis are variable, with higher doses per fraction more likely to induce RN. Furthermore, RN remains a challenging diagnosis for clinicians to make, as its presentation is often nonspecific and imaging studies might not clearly differentiate RN from tumor recurrence or pseudoprogression. RN is initially managed with corticosteroids, followed by bevacizumab, surgical resection, or laser interstitial thermal therapy if symptoms persist. In this review, we examine the literature regarding pathophysiology, incidence, imaging characteristics, and management strategies for radiation necrosis.
放射性坏死（RN）是颅脑放射治疗一种具有挑战性的潜在并发症。RN被认为是由血管、神经胶质和免疫因素的复杂相互作用所致，其确切机制尚不清楚。发生RN的患者通常有立体定向放射外科手术或其他某种形式的放射治疗史。其发生的时间范围不一，但最常发生在放射治疗后的一至三年。据报道，能够诱发放射性坏死的治疗剂量各不相同，每次分割剂量越高，越有可能诱发RN。此外，RN对临床医生来说仍是一个具有挑战性的诊断，因为其表现往往不具有特异性，影像学检查可能无法明确区分RN与肿瘤复发或假性进展。RN最初采用皮质类固醇治疗，如果症状持续，则采用贝伐单抗、手术切除或激光间质热疗。在本综述中，我们研究了有关放射性坏死的病理生理学、发病率、影像学特征和管理策略的文献。
