Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Strenger, V; Lackner, H; Mayer, R; Sminia, P; Sovinz, P; Mokry, M; Pilhatsch, A; Benesch, M; Schwinger, W; Seidel, M; Sperl, D; Schmidt, S; Urban, C.
Incidence and clinical course of radionecrosis in children with brain tumors. A 20-year longitudinal observational study.
Strahlenther Onkol. 2013; 189(9):759-764
Doi: 10.1007/s00066-013-0408-0
Web of Science
PubMed
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- Führende Autor*innen der Med Uni Graz
- Lackner Herwig
- Strenger Volker
- Co-Autor*innen der Med Uni Graz
- Benesch Martin
- Mayer Ramona
- Mokry Michael
- Ritter-Sovinz Petra
- Schwinger Wolfgang
- Seidel Markus
- Sperl Daniela Ingrid
- Urban Ernst-Christian
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- Abstract:
- Radionecrosis (RN) in children treated for brain tumors represents a potentially severe long-term complication. Its diagnosis is challenging, since magnetic resonance imaging (MRI) cannot clearly discriminate between RN and tumor recurrence. A retrospective single-center study was undertaken to describe the incidence and clinical course of RN in a cohort of 107 children treated with external radiotherapy (RT) for various brain tumors between 1992 and 2012. During a median follow-up of 4.6 years (range 0.29-20.1 years), RN was implied by suspicious MRI findings in in 5 children (4.7 %), 5-131 months after RT. Suspicion was confirmed histologically (1 patient) or substantiated by FDG positron-emission tomography (FDG-PET, 2 patients) or by FDG-PET and MR spectroscopy (1 patient). Before developing RN, all 5 patients had received cytotoxic chemotherapy in addition to RT. In addition to standard treatment protocols, 2 patients had received further chemotherapy for progression or relapse. Median radiation dose expressed as the biologically equivalent total dose applied in 2 Gy fractions (EQD2) was 51.7 Gy (range 51.0-60.0 Gy). At RN onset, 4 children presented with neurological symptoms. Treatment of RN included resection (n = 1), corticosteroids (n = 2) and a combination of corticosteroids, hyperbaric oxygen (HBO) and bevacizumab (n = 1). One patient with asymptomatic RN was not treated. Complete radiological regression of the lesions was observed in all patients. Clinical symptoms normalized in 3 patients, whereas 2 developed permanent severe neurological deficits. RN represents a severe long-term treatment complication in children with brain tumors. The spectrum of clinical presentation is wide; ranging from asymptomatic lesions to progressive neurological deterioration. FDG-PET and MR spectroscopy may be useful for distinguishing between RN and tumor recurrence. Treatment options in patients with symptomatic RN include conservative management (steroids, HBO, bevacizumab) and surgical resection.
- Find related publications in this database (using NLM MeSH Indexing)
- Adolescent -
- Adolescent - epidemiology
- Brain Injuries - epidemiology
- Brain Neoplasms - epidemiology
- Child -
- Child, Preschool -
- Comorbidity -
- Female -
- Humans -
- Incidence -
- Infant -
- Longitudinal Studies -
- Male -
- Radiation Injuries - epidemiology
- Radiotherapy, Conformal - statistics & numerical data
- Risk Assessment -
- Treatment Outcome -
- Young Adult -
- Find related publications in this database (Keywords)
- Paediatric oncology
- Radiotherapy
- Chemotherapy
- Late effects
- Cerebral radionecrosis