Article
Radionecrosis in patients treated for primary brain tumours and metastases
Radionekrose nach Behandlung von Patienten mit primären Tumoren und Metastasen
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Published: | June 4, 2021 |
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Objective: Brain necrosis is a well-known phenomenon that is usually attributed to radiotherapy. It can be difficult to diagnose, to treat and might result in neurologic deterioration and mask tumor recurrences. The aim of this study was to investigate the clinical course of histologically diagnosed brain necrosis regarding symptoms, management, outcome and sampling errors.
Methods: We retrospectively reviewed our histopathological data bank for cases with the diagnosis of radionecrosis in patients who underwent surgery for primary intracranial tumors or metastases at our institution between 2008 and 2020. Analysis included onset and symptoms of radionecrosis, radiological features, correlation with radio- and chemotherapy, rate of sampling errors, management and progression of the necrosis.
Results: Nineteen cases (11 males and 8 females, mean age was 61±13 years) were identified with a histopathological diagnosis of radionecrosis. Ten patients (53%) initially had brain metastases of different primary tumors, seven (37%) had primary brain tumors (oligodendroglioma n=4, glioblastoma n=3), one had a pituitary adenoma and one had an anaplastic meningioma. Five patients (26.3%) presented with symptoms and the remaining patients were asymptomatic. Out of all patients, radionecrosis was radiologically considered only in one case prior to the surgery. At diagnosis of radionecrosis, all patients had underwent radiotherapy. Median interval between radiotherapy and diagnosis of radionecrosis was 9 months (range 1 to 40 months) and median dose of radiotherapy was 52 Gy (range 30 to 60 Gy). Seven cases (36.8%) had received chemotherapy concomitantly during radiotherapy. Radionecrosis was treated in 7 patients with corticosteroids, 4 of which showed regression of the lesion and three were stable. The remaining patients were monitored without further treatment, showed no radiological regression but stayed stable. Subsequently, tumor recurrence was diagnosed through a further surgical intervention in 4 patients, with a median interval between diagnosis of radionecrosis and tumor recurrence of 3 months (range 3 to 5 months), suggesting a sampling error rate of 21%.
Conclusion: Radionecrosis is a rare entity that was mainly associated with radiotherapy of brain metastases and primary brain tumors in our series. It mostly showed a benign clinical course with and without treatment with corticosteroids. Close monitoring is mandatory though, as sampling errors occurred at a rate of 21%.