Pathophysiology, diagnosis, and treatment of radiation necrosis in the brain.
Pathophysiology, diagnosis, and treatment of radiation necrosis in the brain.
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DOI：
10.2176/nmc.ra.2014-0188
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发表时间：
2015
影响因子：
1.9
通讯作者：
Kuroiwa T
中科院分区：
文献类型：
--
作者：
Miyatake S;Nonoguchi N;Furuse M;Yoritsune E;Miyata T;Kawabata S;Kuroiwa T
新的放射治疗方式使延长恶性脑肿瘤患者的生存成为可能，但症状性放射坏死成为一个严重的问题，可能会对患者的生活质量产生严重的终身影响。在这里，我们回顾相关文献，并介绍我们最初关于脑、头和颈部肿瘤治疗后脑放射性坏死的病理生理学概念。关于放射性坏死的病理生理学，我们介绍了两个主要的假说：胶质细胞损伤或血管损伤。对于放射性坏死和肿瘤复发的鉴别诊断，我们主要关注正电子发射断层扫描的作用。最后，根据我们关于病理生理学的假设，我们描述了抗血管内皮生长因子抗体贝伐单抗对脑内有症状的放射性坏死的有希望的效果。
New radiation modalities have made it possible to prolong the survival of individuals with malignant brain tumors, but symptomatic radiation necrosis becomes a serious problem that can negatively affect a patient’s quality of life through severe and lifelong effects. Here we review the relevant literature and introduce our original concept of the pathophysiology of brain radiation necrosis following the treatment of brain, head, and neck tumors. Regarding the pathophysiology of radiation necrosis, we introduce two major hypotheses: glial cell damage or vascular damage. For the differential diagnosis of radiation necrosis and tumor recurrence, we focus on the role of positron emission tomography. Finally, in accord with our hypothesis regarding the pathophysiology, we describe the promising effects of the anti-vascular endothelial growth factor antibody bevacizumab on symptomatic radiation necrosis in the brain.