Mangesius Julian, Mangesius Stephanie, Demetz Matthias, Uprimny Christian, Di Santo Gianpaolo, Galijasevic Malik, Minasch Danijela, Gizewski Elke R, Ganswindt Ute, Virgolini Irene, Thomé Claudius, Freyschlag Christian F, Kerschbaumer Johannes
Department of Radiation Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria.
Department of Neuroradiology, Medical University of Innsbruck, 6020 Innsbruck, Austria.
Cancers (Basel). 2022 Dec 19;14(24):6264. doi: 10.3390/cancers14246264.
Radiation necrosis represents a potentially devastating complication after radiation therapy in brain tumors. The establishment of the diagnosis and especially the differentiation from progression and pseudoprogression with its therapeutic implications requires interdisciplinary consent and monitoring. Herein, we want to provide an overview of the diagnostic modalities, therapeutic possibilities and an outlook on future developments to tackle this challenging topic. The aim of this report is to provide an overview of the current morphological, functional, metabolic and evolving imaging tools described in the literature in order to (I) identify the best criteria to distinguish radionecrosis from tumor recurrence after the radio-oncological treatment of malignant gliomas and cerebral metastases, (II) analyze the therapeutic possibilities and (III) give an outlook on future developments to tackle this challenging topic. Additionally, we provide the experience of a tertiary tumor center with this important issue in neuro-oncology and provide an institutional pathway dealing with this problem.
放射性坏死是脑肿瘤放疗后一种潜在的毁灭性并发症。诊断的确立，尤其是与肿瘤进展及假性进展的鉴别及其治疗意义，需要多学科的共识和监测。在此，我们想对诊断方法、治疗可能性以及应对这一具有挑战性主题的未来发展前景作一概述。本报告的目的是概述文献中描述的当前形态学、功能学、代谢学及不断发展的成像工具，以便（I）确定在恶性胶质瘤和脑转移瘤的放射肿瘤学治疗后区分放射性坏死与肿瘤复发的最佳标准，（II）分析治疗可能性，以及（III）对解决这一具有挑战性主题的未来发展作一展望。此外，我们还介绍了一家三级肿瘤中心在神经肿瘤学这一重要问题上的经验，并提供了处理该问题的机构性途径。
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