Brain Radionecrosis

Brain radionecrosis can develop following high-dose fractionated or single-fraction radiation treatments. Most commonly, brain radionecrosis is observed following radiosurgery treatments to the brain or high-dose fractionated radiotherapy treatments to brain tumors, base of skull tumors, and head and neck tumors. The clinical presentation of brain radionecrosis will depend on the location of the brain that is involved. Diagnosis of radionecrosis is commonly based on clinical presentation and radiological characteristics, but a gold standard diagnostic tool is not currently available. Even pathological evaluation can be challenged with the presence of both necrosis and tumor cells. Conventionally, patients are typically started on corticosteroids as the initial treatment for symptomatic radionecrosis. In a subset of patients, corticosteroids are ineffective, and some patients may require surgical resection to remove or alternative treatments. Several alternative local and systemic treatments are under evaluation including laser-induced thermal therapy, hyperbaric oxygen therapy, bevacizumab, and edaravone.