Advances in the prevention and treatment of radiation-induced brain necrosis: a narrative review
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By
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Zhihong Zhao
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Wan He
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Jinquan Xia
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Xiangcheng Wang
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Guixiang Liao
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June 29, 2026
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Clinical Scorecard: Progress in Strategies for Preventing and Managing Radiation-Induced Brain Necrosis: A Comprehensive Review
At a Glance
| Category | Detail |
|---|
| Condition | Radiation-Induced Brain Necrosis |
| Key Mechanisms | Vascular injury and neuroinflammation |
| Target Population | Patients treated for intracranial and head and neck malignancies |
| Care Setting | Neuro-oncology and radiation oncology |
Key Highlights
- Incidence of RBN ranges from 5–25% in patients receiving radiotherapy.
- Key pathophysiological mechanisms include endothelial damage and cytokine release.
- Emerging treatment options include CSF1R inhibitors and laser interstitial thermal therapy.
- Imaging innovations such as MRS and PET/CT enhance early detection of RBN.
- 2022 DEGRO guidelines provide updates on management strategies for RBN.
Guideline-Based Recommendations
Diagnosis
- Use MRI for initial assessment; consider advanced imaging for differential diagnosis.
Management
- First-line treatment includes corticosteroids and bevacizumab; consider HBOT and LITT for refractory cases.
Monitoring & Follow-up
- Asymptomatic RBN should be monitored with serial imaging.
Risks
- Potential for treatment resistance and recurrence after initial response.
Patient & Prescribing Data
Patients with symptomatic and asymptomatic RBN post-radiotherapy.
Management varies from observation to aggressive interventions based on symptom severity.
Clinical Best Practices
- Implement a stepwise approach for symptomatic RBN management.
- Consider individualized treatment plans due to variability in response.
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