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The Neuroradiology Journal Aug 2022Radiation therapy is an important component of treatment in patients with malignancies of the head, neck, and spine. However, radiation to these regions has well-known... (Review)
Review
BACKGROUND AND PURPOSE
Radiation therapy is an important component of treatment in patients with malignancies of the head, neck, and spine. However, radiation to these regions has well-known potential side effects, many of which can be encountered on imaging. In this manuscript, we review selected radiographic manifestations of therapeutic radiation to the head, neck, and spine that may be encountered in the practice of radiology.
METHODS
We conducted an extensive literature review of known complications of radiation therapy in the head, neck, and spine. We excluded intracranial and pulmonary radiation effects from our search. We selected complications that had salient, recognizable imaging findings. We searched our imaging database for illustrative examples of these complications.
RESULTS
Based on our initial literature search and imaging database review, we selected cases of radiation-induced tumors, radiation tissue necrosis (osteoradionecrosis and soft tissue necrosis), carotid stenosis and blowout secondary to radiation, enlarging thyroglossal duct cysts, radiation myelopathy, and radiation-induced vertebral compression fractures.
CONCLUSIONS
We describe the clinical and imaging features of selected sequelae of radiation therapy to the head, neck, and spine, with a focus on those with characteristic imaging findings that can be instrumental in helping to make the diagnosis. Knowledge of these entities and their imaging findings is crucial for accurate diagnosis. Not only do radiologists play a key role in early detection of these entities, but many of these entities can be misinterpreted if one is not familiar with them.
Topics: Fractures, Compression; Head and Neck Neoplasms; Humans; Necrosis; Osteoradionecrosis; Radiation Injuries; Spinal Fractures
PubMed: 35499087
DOI: 10.1177/19714009221096824 -
Journal of Neuro-oncology Mar 2023Cerebral radiation necrosis (RN) is often a delayed phenomenon occurring several months to years after the completion of radiation treatment. Differentiating RN from... (Meta-Analysis)
Meta-Analysis
PURPSOSE
Cerebral radiation necrosis (RN) is often a delayed phenomenon occurring several months to years after the completion of radiation treatment. Differentiating RN from tumor recurrence presents a diagnostic challenge on standard MRI. To date, no evidence-based guidelines exist regarding imaging modalities best suited for this purpose. We aim to review the current literature and perform a diagnostic meta-analysis comparing various imaging modalities that have been studied to differentiate tumor recurrence and RN.
METHODS
A systematic search adherent to PRISMA guidelines was performed using Scopus, PubMed/MEDLINE, and Embase. Pooled sensitivities and specificities were determined using a random-effects or fixed-effects proportional meta-analysis based on heterogeneity. Using diagnostic odds ratios, a diagnostic frequentist random-effects network meta-analysis was performed, and studies were ranked using P-score hierarchical ranking.
RESULTS
The analysis included 127 studies with a total of 220 imaging datasets, including the following imaging modalities: MRI (n = 10), MR Spectroscopy (MRS) (n = 28), dynamic contrast-enhanced MRI (n = 7), dynamic susceptibility contrast MRI (n = 36), MR arterial spin labeling (n = 5), diffusion-weighted imaging (n = 13), diffusion tensor imaging (DTI) (n = 2), PET (n = 89), and single photon emission computed tomography (SPECT) (n = 30). MRS had the highest pooled sensitivity (90.7%). DTI had the highest pooled specificity (90.5%). Our hierarchical ranking ranked SPECT and MRS as most preferable, and MRI was ranked as least preferable.
CONCLUSION
These findings suggest SPECT and MRS carry greater utility than standard MRI in distinguishing RN from tumor recurrence.
Topics: Humans; Diffusion Tensor Imaging; Magnetic Resonance Imaging; Necrosis; Neoplasm Recurrence, Local; Sensitivity and Specificity; Tomography, Emission-Computed, Single-Photon
PubMed: 36853489
DOI: 10.1007/s11060-023-04262-1 -
Neuroradiology Apr 2021Radiation therapy is commonly utilized in the majority of solid cancers and many hematologic malignancies and other disorders. While it has an undeniably major role in... (Review)
Review
BACKGROUND AND PURPOSE
Radiation therapy is commonly utilized in the majority of solid cancers and many hematologic malignancies and other disorders. While it has an undeniably major role in improving cancer survival, radiation therapy has long been recognized to have various negative effects, ranging from mild to severe. In this manuscript, we review several intracranial manifestations of therapeutic radiation, with particular attention to those that may be encountered by radiologists.
METHODS
We conducted an extensive literature review of known complications of intracranial radiation therapy. Based on this review, we selected complications that had salient, recognizable imaging findings. We searched our imaging database for illustrative examples of these complications, focusing only on patients who had a history of intracranial radiation therapy. We then selected cases that best exemplified expected imaging findings in these entities.
RESULTS
Based on our initial literature search and imaging database review, we selected cases of radiation-induced meningioma, radiation-induced glioma, cavernous malformation, enlarging perivascular spaces, leukoencephalopathy, stroke-like migraine after radiation therapy, Moyamoya syndrome, radiation necrosis, radiation-induced labyrinthitis, optic neuropathy, and retinopathy. Although retinopathy is not typically apparent on imaging, it has been included given its clinical overlap with optic neuropathy.
CONCLUSIONS
We describe the clinical and imaging features of selected sequelae of intracranial radiation therapy, with a focus on those most relevant to practicing radiologists. Knowledge of these complications and their imaging findings is important, because radiologists play a key role in early detection of these entities.
Topics: Humans; Meningioma; Neoplasms, Radiation-Induced; Optic Nerve; Radiation Injuries
PubMed: 33392738
DOI: 10.1007/s00234-020-02621-7 -
Advanced Biosystems Dec 2020Liquid biopsy for the detection and monitoring of central nervous system tumors is of significant clinical interest. At initial diagnosis, the majority of patients with... (Review)
Review
Liquid biopsy for the detection and monitoring of central nervous system tumors is of significant clinical interest. At initial diagnosis, the majority of patients with central nervous system tumors undergo magnetic resonance imaging (MRI), followed by invasive brain biopsy to determine the molecular diagnosis of the WHO 2016 classification paradigm. Despite the importance of MRI for long-term treatment monitoring, in the majority of patients who receive chemoradiation therapy for glioblastoma, it can be challenging to distinguish between radiation treatment effects including pseudoprogression, radiation necrosis, and recurrent/progressive disease based on imaging alone. Tissue biopsy-based monitoring is high risk and not always feasible. However, distinguishing these entities is of critical importance for the management of patients and can significantly affect survival. Liquid biopsy strategies including circulating tumor cells, circulating free DNA, and extracellular vesicles have the potential to afford significant useful molecular information at both the stage of diagnosis and monitoring for these tumors. Here, current liquid biopsy-based approaches in the context of tumor monitoring to differentiate progressive disease from pseudoprogression and radiation necrosis are reviewed.
Topics: Biomarkers, Tumor; Brain; Brain Neoplasms; Circulating Tumor DNA; Disease Progression; Extracellular Vesicles; Glioblastoma; Humans; Liquid Biopsy; Necrosis; Neoplastic Cells, Circulating; Radiation Injuries; Radiotherapy
PubMed: 32484293
DOI: 10.1002/adbi.202000029 -
Undersea & Hyperbaric Medicine :... 2023Radiation therapy to the pelvis can result in radiation-induced vaginal soft tissue necrosis. This significantly impacts quality of life. Studies evaluating the efficacy... (Review)
Review
INTRODUCTION
Radiation therapy to the pelvis can result in radiation-induced vaginal soft tissue necrosis. This significantly impacts quality of life. Studies evaluating the efficacy of HBO2 are limited.
METHODS
In this retrospective report, we reviewed the medical records of patients treated with once-daily HBO2 for radiation-induced vaginal soft tissue necrosis. We included females between the ages of 18 to 90 with history of pelvic cancer treated with radiotherapy and resultant soft tissue radionecrosis. Data collected included age, comorbid disease, cancer type, radiation dose, HBO2 treatment pressure, time, and total treatments. Primary outcome was improvement of radionecrosis; secondary outcomes were improvement of pelvic pain, reduction in need for analgesia, and improvement of vaginal bleeding.
RESULTS
Seven patients were identified, of which six received HBO2. One patient had a vaginal fistula. Four patients had documented improvement of radionecrosis. Four out of five patients with pelvic pain had resolution of their pain, with two patients no longer requiring opioid analgesia. Two patients who presented with vaginal bleeding showed improvement with one resolved and one significantly decreased requiring no further hospitalization or transfusion. One patient experienced no documented improvement in any of the measured outcomes.
CONCLUSION
In this case series, five out of six (83%) patients treated with HBO2 for radiation-induced vaginal necrosis improved in at least one outcome measure. While the sample size is small, these results add to the data available that supports the use of HBO2 in suitable candidates without contraindications who have symptoms related to radiation-induced vaginal soft tissue necrosis.
Topics: Female; Humans; Adolescent; Young Adult; Adult; Middle Aged; Aged; Aged, 80 and over; Retrospective Studies; Quality of Life; Hyperbaric Oxygenation; Radiation Injuries; Necrosis; Uterine Hemorrhage; Pelvic Pain
PubMed: 36820802
DOI: 10.22462/01.01.2023.16 -
Journal of Clinical Neuroscience :... Oct 2023With the widespread use of stereotactic radiosurgery (SRS), post-radiation treatment effects (PTREs) are increasing in prevalence. Radiation necrosis (RN) is a serious... (Review)
Review
INTRODUCTION
With the widespread use of stereotactic radiosurgery (SRS), post-radiation treatment effects (PTREs) are increasing in prevalence. Radiation necrosis (RN) is a serious PTRE which carries a poor prognosis. Since 2012, laser interstitial thermal therapy (LITT) has been used to treat RN. However, reviews have attempting to generalise the efficacy of LITT against biopsy-proven RN are limited. In this systematic review, patient demographic characteristics and post-LITT clinical outcomes are characterised.
METHODS
A systematic literature search was conducted in four major databases for cohort studies and case reports published between 2012 and 2022, following the PRISMA 2020 checklist. Data was extracted and descriptively analysed. Quality of reporting was assessed using the PROCESS criteria and reporting bias was evaluated using the ROBINS-I scoring system.
RESULTS
Eleven studies met our inclusion criteria, with an overall moderate risk of reporting bias being observed. Mean pre-LITT target lesion volume was 6.75 cm, and was independent of gender, time since SRS, age and number of interventions prior to LITT.
DISCUSSION AND CONCLUSION
LITT is a versatile treatment option which may be used to treat a vast range of patients with refractory biopsy-proven RN. However, neurosurgeons should exercise caution when selecting patients for LITT due to insufficient data on the treatment's efficacy against biopsy-proven RN. This warrants further studies to unequivocally determine the safety and clinical outcomes.
Topics: Humans; Biopsy; Hyperthermia, Induced; Checklist; Databases, Factual; Radiation Injuries; Necrosis
PubMed: 37639807
DOI: 10.1016/j.jocn.2023.08.020 -
Journal of Medical Imaging and... Apr 2023Balancing disease control and treatment-related toxicities can be challenging when treating higher-risk brain metastases (BMs) that are larger in size or eloquent...
Radiation necrosis and therapeutic outcomes in patients treated with linear accelerator-based hypofractionated stereotactic radiosurgery for intact intracranial metastases.
INTRODUCTION
Balancing disease control and treatment-related toxicities can be challenging when treating higher-risk brain metastases (BMs) that are larger in size or eloquent anatomical locations. Hypofractionated stereotactic radiosurgery (hfSRS) is expected to offer superior or equal efficacy with lower toxicity profile compared with single-fraction SRS (sfSRS). We report the efficacy and toxicity profiles of hfSRS in a consecutive cohort of patients to support this predicted benefit from hfSRS for high-risk BMs.
METHODS
We retrospectively analysed 185 consecutive individual lesions from 152 patients with intact BMs treated with hfSRS between 1 July 2016 and 31 October 2019 and followed up to 30 April 2022 with serial brain magnetic resonance imaging (MRI). The primary endpoint was the event of radiation necrosis (RN). Local control (LC) rate and distant brain failure (DBF) were reported as secondary outcomes. Kaplan-Meier method was used to report the cumulative incidence of RN and overall survival and the incidence of DBF. Potential risk factors for RN were assessed using univariable Cox regression analysis.
RESULTS
The median follow-up was 38.0 months, and the median survival post-SRS was 9.5 months. The cumulative incidence rate of RN was 13.2% (95% CI: 7.0-24.7%), and 18.1% of patients with confirmed RN were symptomatic. Higher mean dose delivered to planning target volume (PTV) (HR 1.22, 95% CI: 1.05-1.42, P = 0.01), higher mean BED (biological equivalent dose assuming a tissue ratio of 10) (HR 1.12, 95% CI: 1.04-1.2, P < 0.001), and higher mean BED (HR 1.02, 95% CI: 1-1.04, P = 0.04) delivered to the lesion was associated with increased risk of RN. LC rate was 86% and the cumulative incidence of DBF was 36% with a median onset of 28.4 months.
CONCLUSIONS
Our results support the predicted radiobiological benefit of the use of hfSRS in high-risk BMs to limit treatment-related toxicity with low risk for symptomatic RN comparable with lower risk population receiving sfSRS while achieving satisfactory local disease control.
Topics: Humans; Radiosurgery; Retrospective Studies; Particle Accelerators; Brain Neoplasms; Risk Factors; Radiation Injuries; Treatment Outcome; Necrosis
PubMed: 36847751
DOI: 10.1111/1754-9485.13519 -
Radiologic Clinics of North America Nov 2019Radiographic monitoring of posttreatment glioblastoma is important for clinical trials and determining next steps in management. Evaluation for tumor progression is... (Review)
Review
Radiographic monitoring of posttreatment glioblastoma is important for clinical trials and determining next steps in management. Evaluation for tumor progression is confounded by the presence of treatment-related radiographic changes, making a definitive determination less straight-forward. The purpose of this article was to describe imaging tools available for assessing treatment response in glioblastoma, as well as to highlight the definitions, pathophysiology, and imaging features typical of true progression, pseudoprogression, pseudoresponse, and radiation necrosis.
Topics: Brain; Brain Neoplasms; Diagnostic Imaging; Disease Progression; Glioblastoma; Humans; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Multimodal Imaging; Necrosis; Positron-Emission Tomography; Radiation Injuries
PubMed: 31582045
DOI: 10.1016/j.rcl.2019.07.003 -
Folia Neuropathologica 2023This study focuses on the challenge of distinguishing between tumour recurrence and radiation necrosis in glioma treatment using magnetic resonance imaging (MRI)....
INTRODUCTION
This study focuses on the challenge of distinguishing between tumour recurrence and radiation necrosis in glioma treatment using magnetic resonance imaging (MRI). Currently, accurate differentiation is possible only through surgical biopsy, which is invasive and may cause additional damage. The study explores non-invasive methods using dynamic susceptibility contrast (DSC) MR perfusion with parameters like relative peak height (rPH) and relative percentage of signal-intensity recovery (rPSR).
MATERIAL AND METHODS
Among retrospectively evaluated patients (multicentre study) with an initial diagnosis of the primary and secondary brain tumour, 47 met the inclusion criteria and were divided into two groups, the recurrent glioblastoma (GBM) WHO IV group and the radiation necrosis group, based on MRI of the brain. All patients enrolled into the recurrent GBM group had a second surgical intervention.
RESULTS
Mean, minimum and maximum rPH values were significantly higher in the recurrent GBM group than in the radiation necrosis group ( p < 0.001), while rPSR values were lower in the recurrent GBM group than in the radiation necrosis group ( p = 0.011 and p = 0.012).
DISCUSSION
This study investigates the use of MR perfusion curve characteristics to differentiate between radiation necrosis and glioblastoma recurrence in post-treatment brain tumours. MR perfusion shows promising potential for distinguishing between the two conditions, but it also has certain limitations. Despite challenges in finding a sufficient cohort size, the study demonstrates significant differences in MR perfusion parameters between radiation necrosis and GBM recurrence.
CONCLUSIONS
The results demonstrate the potential usefulness of these DSC perfusion parameters in discriminating between glioblastoma recurrence and radiation necrosis.
Topics: Humans; Glioblastoma; Retrospective Studies; Magnetic Resonance Imaging; Brain Neoplasms; Perfusion; Necrosis; Diagnosis, Differential
PubMed: 38282486
DOI: 10.5114/fn.2023.134180 -
Neuroimaging Clinics of North America Feb 2021Radiographic monitoring of posttreatment glioblastoma is important for clinical trials and determining next steps in management. Evaluation for tumor progression is... (Review)
Review
Radiographic monitoring of posttreatment glioblastoma is important for clinical trials and determining next steps in management. Evaluation for tumor progression is confounded by the presence of treatment-related radiographic changes, making a definitive determination less straight-forward. The purpose of this article was to describe imaging tools available for assessing treatment response in glioblastoma, as well as to highlight the definitions, pathophysiology, and imaging features typical of true progression, pseudoprogression, pseudoresponse, and radiation necrosis.
Topics: Brain; Brain Neoplasms; Contrast Media; Diagnostic Imaging; Disease Progression; Fluorodeoxyglucose F18; Glioblastoma; Humans; Image Enhancement; Magnetic Resonance Imaging; Necrosis; Positron-Emission Tomography; Radiation Injuries; Radiopharmaceuticals; Treatment Outcome
PubMed: 33220823
DOI: 10.1016/j.nic.2020.09.010