Recurrent Brain Metastasis Versus Radiation-Induced Necrosis: A Case Report and Literature Review

Radiotherapy is the cornerstone of brain metastasis management. With the advancement of therapies, patients are living longer, exposing them to the long-term effects of radiotherapy. Using concurrent or sequential chemotherapy, targeted agents, and immune checkpoint inhibitors may increase the incidence and severity of radiation-induced toxicity. Recurrent metastasis and radiation necrosis (RN) appear indistinguishable on neuroimaging, making it a diagnostic dilemma for clinicians. Here, we present a case of RN in a 65-year-old male patient who previously had brain metastasis (BM) from primary lung cancer, misdiagnosed initially as recurrent BM.

[1]  K. Abdullah,et al.  Bevacizumab vs laser interstitial thermal therapy in cerebral radiation necrosis from brain metastases: a systematic review and meta-analysis , 2021, Journal of Neuro-Oncology.

[2]  P. Brown,et al.  A nomogram to predict symptomatic epilepsy in patients with radiation-induced brain necrosis , 2020, Neurology.

[3]  M. Shamim,et al.  MR perfusion imaging, techniques and role in differentiating radiation necrosis and tumor recurrence. , 2019, JPMA. The Journal of the Pakistan Medical Association.

[4]  T. Batchelor,et al.  Treatment-Induced Brain Tissue Necrosis: A Clinical Challenge in Neuro-Oncology. , 2019, Neuro-oncology.

[5]  S. Lo,et al.  Diagnosis and Management of Radiation Necrosis in Patients With Brain Metastases , 2018, Front. Oncol..

[6]  S. Miyatake,et al.  Pathophysiology, Diagnosis, and Treatment of Radiation Necrosis in the Brain , 2014, Neurologia medico-chirurgica.

[7]  P. Sminia,et al.  Incidence and clinical course of radionecrosis in children with brain tumors , 2013, Strahlentherapie und Onkologie.

[8]  J. Ruben,et al.  Cerebral radiation necrosis: incidence, outcomes, and risk factors with emphasis on radiation parameters and chemotherapy. , 2006, International journal of radiation oncology, biology, physics.

[9]  C. Wong,et al.  Molecular targets in radiation-induced blood-brain barrier disruption. , 2005, International journal of radiation oncology, biology, physics.

[10]  P. Black,et al.  Dual-isotope single-photon emission computerized tomography scanning in patients with glioblastoma multiforme: association with patient survival and histopathological characteristics of tumor after high-dose radiotherapy. , 1998, Journal of neurosurgery.

[11]  L. Henke,et al.  Approach to the patient with radiation necrosis , 2021 .