Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany; National Center for Tumor diseases (NCT), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.
Department of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Health at Long Island, New York, NY, USA.
Radiother Oncol. 2022 Oct;175:133-143. doi: 10.1016/j.radonc.2022.08.025. Epub 2022 Aug 27.
Radiation-induced contrast enhancements (RICE) are a common side effect following radiotherapy for glioma, but both diagnosis and handling are challenging. Due to the potential risks associated with RICE and its challenges in differentiating RICE from tumor progression, it is critical to better understand how RICE prognosis depends on iatrogenic influence.
We identified 99 patients diagnosed with RICE who were previously treated with either photon or proton therapy for World Health Organization (WHO) grade 1-3 primary gliomas. Post-treatment brain MRI-based volumetric analysis and clinical data collection was performed at multiple time points.
The most common histologic subtypes were astrocytoma (50%) and oligodendroglioma (46%). In 67%, it was graded WHO grade 2 and in 86% an IDH mutation was present. RICE first occurred after 16 months (range: 1-160) in median. At initial RICE occurrence, 39% were misinterpreted as tumor progression. A tumor-specific therapy including chemotherapy or re-irradiation led to a RICE size progression in 86% and 92% of cases, respectively and RICE symptom progression in 57% and 65% of cases, respectively. A RICE-specific therapy such as corticosteroids or Bevacizumab for larger or symptomatic RICE led to a RICE size regression in 81% of cases with symptom stability or regression in 62% of cases.
While with chemotherapy and re-irradiation a RICE progression was frequently observed, anti-edematous or anti-VEGF treatment frequently went along with a RICE regression. For RICE, correct diagnosis and treatment decisions are challenging and critical and should be made interdisciplinarily.
放疗后出现的放射性对比增强（RICE）是脑胶质瘤放疗后的常见副作用，但诊断和处理都具有挑战性。由于 RICE 存在潜在风险，且其与肿瘤进展的鉴别具有挑战性，因此更好地了解 RICE 的预后如何取决于医源性影响至关重要。
我们确定了 99 例 RICE 患者，这些患者曾因世界卫生组织（WHO）1-3 级原发性脑胶质瘤接受光子或质子治疗。在多个时间点进行了治疗后基于脑 MRI 的容积分析和临床数据收集。
最常见的组织学亚型是星形细胞瘤（50%）和少突胶质细胞瘤（46%）。在 67%的患者中，其分级为 WHO 2 级，在 86%的患者中存在 IDH 突变。RICE 首次发生于中位数 16 个月（范围：1-160）后。在 RICE 首次发生时，有 39%被误诊为肿瘤进展。肿瘤特异性治疗，包括化疗或再放疗，分别导致 86%和 92%的 RICE 体积进展，分别导致 57%和 65%的 RICE 症状进展。对于较大或有症状的 RICE，采用皮质类固醇或贝伐单抗等 RICE 特异性治疗，可使 81%的病例 RICE 体积缩小，62%的病例症状稳定或缓解。
虽然化疗和再放疗常导致 RICE 进展，但抗水肿或抗 VEGF 治疗常伴随着 RICE 消退。对于 RICE，正确的诊断和治疗决策具有挑战性和关键性，应跨学科进行。
