Radiation necrosis of the brain

Abstract

Radiation necrosis of the brain (BRN) is the most frequent and dangerous iatrogenic complication of radiation therapy of tumors and non-tumor diseases of the brain and the base of the skull. The risk of its development increases with an increase in the amount of radiation, single and total doses and due to synergy with the action of adjuvant chemotherapy used. The pathogenesis of BRN is based on damage to the microcirculatory bed in the tumor and surrounding tissues with the development of edema and impaired trophic neuroglia with its necrosis, which in most cases are irreversible. After treatment of brain tumors, differential diagnosis of BRN is carried out with the resumption of tumor growth or its pseudoprogression and requires the use of a set of imaging methods. Treatment of BRN in separate patients may consist of surgical removal of the necrotic area, but in most patients it is possible to carry out only drug therapy with corticosteroid and anti-VEGF drugs that allow to slow down the development of BRN, improve the quality of life and prolong its.