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Journal of Neuro-oncology Dec 2020Radiation therapy (RT) is often necessary for the treatment of head and neck cancers. Osteoradionecrosis (ORN) is a rare, but potentially serious complication of RT. RT... (Review)
Review
Radiation therapy (RT) is often necessary for the treatment of head and neck cancers. Osteoradionecrosis (ORN) is a rare, but potentially serious complication of RT. RT leads to the destruction of vasculature in radiated tissue causing hypoxia and tissue necrosis. ORN can occur in any bone, but bones with naturally poor blood supply appear to be more susceptible. Bones of the skull base are susceptible, with ORN occurring in the anterior, central, and lateral skull base. Risk factors include cancer type and location, radiation dose, and a variety of patient factors. Patients often present with pain, bleeding, and foul odor and are typically found to have exposed and necrotic bone. Treatment options vary depending on the severity, but typically include pentoxifylline and vitamin E as well as surgical debridement, with less evidence supporting hyperbaric oxygen therapy. Recognition and prompt treatment of ORN will allow for improved patient outcomes.
Topics: Animals; Head and Neck Neoplasms; Humans; Osteoradionecrosis; Radiotherapy; Skull Base Neoplasms
PubMed: 32394326
DOI: 10.1007/s11060-020-03462-3 -
Practical Neurology Oct 2021Cerebral radiation necrosis is the most serious late reaction to high doses of ionising radiation to the brain, and its treatment is generally unsatisfactory. We present...
Cerebral radiation necrosis is the most serious late reaction to high doses of ionising radiation to the brain, and its treatment is generally unsatisfactory. We present a patient who developed cerebral radiation necrosis after protracted fluoroscopy during repeated embolisations of an extracranial arteriovenous malformation. Treatment with bevacizumab (a humanised murine monoclonal antibody against vascular endothelial growth factor) was followed by neurological and radiological improvements.
Topics: Animals; Bevacizumab; Humans; Iatrogenic Disease; Mice; Necrosis; Radiation Injuries; Vascular Endothelial Growth Factor A
PubMed: 34050003
DOI: 10.1136/practneurol-2020-002904 -
Radiotherapy and Oncology : Journal of... Dec 2023Emerging data suggest immune checkpoint inhibitors (ICI) and stereotactic radiosurgery (SRS) or radiotherapy (SRT) may work synergistically, potentially increasing both...
BACKGROUND AND PURPOSE
Emerging data suggest immune checkpoint inhibitors (ICI) and stereotactic radiosurgery (SRS) or radiotherapy (SRT) may work synergistically, potentially increasing both efficacy and toxicity. This manuscript characterizes factors associated with intracranial control and radiation necrosis in this group.
MATERIALS AND METHODS
All patients had non-small cell lung cancer, renal cell carcinoma, or melanoma and were treated from 2013 to 2021 at two institutions with ICI and SRS/SRT. Univariate and multivariate analysis were used to analyze factors associated with local failure (LF) and grade 2+ (G2 + ) radiation necrosis.
RESULTS
There were 179 patients with 549 metastases. The median follow up from SRS/SRT was 14.7 months and the median tumor size was 7 mm (46 tumors ≥ 20 mm). Rates of LF and G2 + radiation necrosis per metastasis were 5.8% (32/549) and 6.9% (38/549), respectively. LF rates for ICI +/- 1 month from time of radiation versus not were 3% (8/264) and 8% (24/285) (p = 0.01), respectively. G2 + radiation necrosis rates for PD-L1 ≥ 50% versus < 50% were 17% (11/65) and 3% (5/203) (p=<0.001), respectively. PD-L1 ≥ 50% remained significantly associated with G2 + radiation necrosis on multivariate analysis (p = 0.03). Rates of intracranial failure were 54% (80/147) and 17% (4/23) (p = 0.001) for those without and with G2 + radiation necrosis, respectively.
CONCLUSIONS
PD-L1 expression (≥50%) may be associated with higher rates of G2 + radiation necrosis, and there may be improved intracranial control following the development of radiation necrosis. Administration of ICIs with SRS/SRT is overall safe, and there may be some local control benefit to delivering these concurrently.
Topics: Humans; Radiosurgery; Immune Checkpoint Inhibitors; Carcinoma, Non-Small-Cell Lung; B7-H1 Antigen; Lung Neoplasms; Brain Neoplasms; Radiation Injuries; Kidney Neoplasms; Necrosis; Retrospective Studies
PubMed: 37769968
DOI: 10.1016/j.radonc.2023.109920 -
Neurosurgery Clinics of North America Oct 2020Radiation necrosis (RN) occurs in 5% to 25% of patients with brain metastases treated with stereotactic radiosurgery. RN must be distinguished from recurrent tumor to... (Review)
Review
Radiation necrosis (RN) occurs in 5% to 25% of patients with brain metastases treated with stereotactic radiosurgery. RN must be distinguished from recurrent tumor to determine appropriate treatment. Stereotactic biopsy remains the gold standard for identifying RN. Initial treatment of RN often involves management of edema using corticosteroids, antiangiogenic therapies, and hyperbaric oxygen therapy. For refractory symptoms, surgical resection can be considered. Minimally invasive stereotactic laser ablation has the benefit of providing tissue diagnosis and treating RN or recurrent tumor with similar efficacy. Laser ablation should be considered for lesions in need of intervention where the diagnosis requires tissue confirmation.
Topics: Brain; Brain Neoplasms; Humans; Necrosis; Neoplasm Recurrence, Local; Radiation Injuries; Radiotherapy; Treatment Outcome
PubMed: 32921353
DOI: 10.1016/j.nec.2020.06.007 -
Methods in Molecular Biology (Clifton,... 2022The clearance of dead cells by macrophages, termed "efferocytosis," drives the resolution of inflammation, restricts necrosis, and restores homeostasis. Defects in...
The clearance of dead cells by macrophages, termed "efferocytosis," drives the resolution of inflammation, restricts necrosis, and restores homeostasis. Defects in efferocytosis contribute to many diseases, particularly atherosclerosis. Multiple methods to test efferocytosis by macrophages in vitro exist, but each has distinct disadvantages. This chapter describes an improved method to test apoptotic cell binding and internalization by bone marrow-derived macrophages that takes advantage of the high-affinity between streptavidin and biotin.
Topics: Apoptosis; Fluorescence; Humans; Macrophages; Necrosis; Phagocytosis
PubMed: 35237972
DOI: 10.1007/978-1-0716-1924-7_18 -
Dental Clinics of North America Apr 2024This article defines the fascial and spatial anatomy of the suprahyoid neck region, delineates the role of CT and MR imaging, discusses the inflammatory conditions of... (Review)
Review
This article defines the fascial and spatial anatomy of the suprahyoid neck region, delineates the role of CT and MR imaging, discusses the inflammatory conditions of the jaws and adjacent spaces and their clinical symptomatology, and illustrates the appearance of these conditions.
Topics: Humans; Osteoradionecrosis; Jaw; Jaw Diseases; Magnetic Resonance Imaging; Osteonecrosis
PubMed: 38417990
DOI: 10.1016/j.cden.2023.09.003 -
Gynecologic Oncology Feb 2021Vaginal necrosis is a late radiation tissue injury with serious morbidity complications. It is rare, and its incidence is not well assessed in prospective trials.... (Review)
Review
Vaginal necrosis is a late radiation tissue injury with serious morbidity complications. It is rare, and its incidence is not well assessed in prospective trials. Patient comorbidities and radiation dose can significantly increase the risk. As treatment of gynecologic malignancies often involve a multidisciplinary approach, timely diagnosis and appropriate management by physicians of the team are crucial. Untreated vaginal necrosis can lead to infection, hemorrhage, necrosis-related fistulation to the bladder or rectum, perforation, and death. In this review, we describe the pathophysiology of vaginal necrosis, its clinical course, and management options.
Topics: Anti-Bacterial Agents; Combined Modality Therapy; Debridement; Female; Genital Neoplasms, Female; Humans; Hydrogen Peroxide; Hyperbaric Oxygenation; Incidence; Necrosis; Radiation Injuries; Radiotherapy Dosage; Risk Factors; Treatment Outcome; Vagina; Vaginal Douching
PubMed: 33303211
DOI: 10.1016/j.ygyno.2020.11.025 -
Current Treatment Options in Oncology Jun 2021Intracranial stereotactic radiosurgery (SRS) is an effective and convenient treatment for many brain conditions. Data regarding safety come mostly from retrospective... (Review)
Review
Intracranial stereotactic radiosurgery (SRS) is an effective and convenient treatment for many brain conditions. Data regarding safety come mostly from retrospective single institutional studies and a small number of prospective studies. Variations in target delineation, treatment delivery, imaging follow-up protocols and dose prescription limit the interpretation of this data. There has been much clinical focus on radiation necrosis (RN) in particular, as it is being increasingly recognized on follow-up imaging. Symptomatic RN may be treated with medical therapy (such as corticosteroids and bevacizumab) with surgical resection being reserved for refractory patients. Nevertheless, RN remains a challenging condition to manage, and therefore upfront patient selection for SRS remains critical to provide complication-free control. Mitigation strategies need to be considered in situations where the baseline risk of RN is expected to be high-such as large target volume or re-irradiation. These may involve reduction in the prescribed dose or hypofractionated stereotactic radiation therapy (HSRT). Recently published guidelines and international meta-analysis report the benefit of HSRT in larger lesions, without compromising control rates. However, careful attention to planning parameters and SRS techniques still need to be adhered, even with HSRT. In cases where the risk is deemed to be high despite mitigation, a combination approach of surgery with or without post-operative radiation should be considered.
Topics: Brain Neoplasms; Humans; Necrosis; Radiation Injuries; Radiosurgery; Tumor Burden
PubMed: 34097171
DOI: 10.1007/s11864-021-00854-z -
Radiation Oncology (London, England) Feb 2021Frequency and risk profile of radiation necrosis (RN) in patients with glioma undergoing either upfront stereotactic brachytherapy (SBT) and additional salvage external...
PURPOSE
Frequency and risk profile of radiation necrosis (RN) in patients with glioma undergoing either upfront stereotactic brachytherapy (SBT) and additional salvage external beam radiotherapy (EBRT) after tumor recurrence or vice versa remains unknown.
METHODS
Patients with glioma treated with low-activity temporary iodine-125 SBT at the University of Munich between 1999 and 2016 who had either additional upfront or salvage EBRT were included. Biologically effective doses (BED) were calculated. RN was diagnosed using stereotactic biopsy and/or metabolic imaging. The rate of RN was estimated with the Kaplan Meier method. Risk factors were obtained from logistic regression models.
RESULTS
Eighty-six patients (49 male, 37 female, median age 47 years) were included. 38 patients suffered from low-grade and 48 from high-grade glioma. Median follow-up was 15 months after second treatment. Fifty-eight patients received upfront EBRT (median total dose: 60 Gy), and 28 upfront SBT (median reference dose: 54 Gy, median dose rate: 10.0 cGy/h). Median time interval between treatments was 19 months. RN was diagnosed in 8/75 patients. The 1- and 2-year risk of RN was 5.1% and 11.7%, respectively. Tumor volume and irradiation time of SBT, number of implanted seeds, and salvage EBRT were risk factors for RN. Neither of the BED values nor the time interval between both treatments gained prognostic influence.
CONCLUSION
The combination of upfront EBRT and salvage SBT or vice versa is feasible for glioma patients. The risk of RN is mainly determined by the treatment volume but not by the interval between therapies.
Topics: Adolescent; Adult; Aged; Brachytherapy; Female; Glioma; Humans; Iodine Radioisotopes; Male; Middle Aged; Necrosis; Neoplasm Recurrence, Local; Radiation Injuries; Radiotherapy Dosage; Re-Irradiation; Retrospective Studies; Risk Factors; Salvage Therapy; Treatment Outcome; Young Adult
PubMed: 33622365
DOI: 10.1186/s13014-021-01762-0 -
Radiation Oncology (London, England) Jun 2020Murine models are among the most common type of preclinical animal models used to study the human condition, but a wide selection of different mice is currently in use...
BACKGROUND
Murine models are among the most common type of preclinical animal models used to study the human condition, but a wide selection of different mice is currently in use with these differences potentially compromising study results and impairing the ability to reconcile interstudy results. Our goal was to determine how the strain and sex of the mice selection would affect the development of radiation necrosis in our murine model of radiation-induced cerebral necrosis.
METHODS
We generated this model by using a preclinical irradiator to irradiate a sub-hemispheric portion of the brain of mice with single-fraction doses of 80 Gy. Eight possible combinations of mice made up of two different with two substrains each (BALB/cN, BALB/cJ, C57BL/6 N, and C57BL/6 J) and both sexes were irradiated in this study. Radiation necrosis development was tracked up to 8 weeks with a 7 T Bruker MRI utilizing T2-weighted and post-contrast T1-weighted imaging. MRI results were compared to and validated with the use of histology which utilized a scale from 0 to 3 in ascending order of damage.
RESULTS
Both time post-irradiation and strain (BALB/c vs C57BL/6) were significant factors affecting radiation necrosis development. Sex was in general not a statistically significant parameter in terms of radiation necrosis development.
CONCLUSION
Mouse strain thus needs to be considered when evaluating the results of necrosis models. However, sex does not appear to be a variable needing major consideration.
Topics: Animals; Brain; Disease Models, Animal; Female; Male; Mice; Mice, Inbred BALB C; Mice, Inbred C57BL; Necrosis; Radiation Injuries, Experimental
PubMed: 32493371
DOI: 10.1186/s13014-020-01585-5