Objective:

To synthesize contemporary insights into the pathophysiology and evolving strategies for the prevention and treatment of radiation-induced brain necrosis (RBN).

Approach:

• Review Methodology: This narrative review synthesizes current knowledge on RBN prevention and treatment based on the authors’ expertise and a focused literature review, without a formal systematic search.

Key Findings:

• RBN incidence ranges from 5-25% in patients undergoing radiotherapy for intracranial and head and neck malignancies.
• Key pathogenesis factors include vascular injury and neuroinflammation.
• Recent preventive strategies involve advanced radiotherapy techniques and pharmacological prophylaxis.
• Treatment options include corticosteroids, bevacizumab, hyperbaric oxygen therapy, and emerging therapies like CSF1R inhibitors.
• Imaging innovations such as MRS, PWI, and PET/CT enhance early detection and differential diagnosis.

Interpretation:

RBN presents significant clinical challenges, including diagnostic dilemmas and treatment resistance, necessitating ongoing research and optimization of therapeutic strategies.

Limitations:

• The review does not include a formal quality assessment or quantitative synthesis of the evidence.
• It is based on a non-systematic literature review rather than a comprehensive systematic search.

Conclusion:

The review highlights the need for effective prevention and management strategies for RBN as radiotherapy techniques evolve.