Journal
RADIOTHERAPY AND ONCOLOGY
Volume 175, Issue -, Pages 133-143Publisher
ELSEVIER IRELAND LTD
DOI: 10.1016/j.radonc.2022.08.025
Keywords
Radiation necrosis; Pseudoprogression; Blood brain barrier disruption; Chemotherapy; Re-irradiation; Anti-VEGF antibody Bevacizumab
Funding
- Clinician-Scientist Fellowship of the Heidelberg Research College for Neurooncology of Heidelberg University
- German Ministry for research and Education [13GW0436A]
- Deutsche Forschungsgemeinschaft
- Herbert Kienzle Foundation
- Else Kroner-Fresenius Foundation
- Ruprecht-Karls-Universitat Heidelberg
- Baden-Wuerttemberg Ministry of Science, Research and the Arts
- Ruprecht-Karls-Universitat Heidelberg
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Radiation-induced contrast enhancements (RICE) are a common side effect following radiotherapy for gliomas, and correct diagnosis and treatment decisions for RICE are challenging. Research shows that different treatments result in varying outcomes for RICE, emphasizing the importance of making the right treatment decisions.
Background and purpose: Radiation-induced contrast enhancements (RICE) are a common side effect fol-lowing radiotherapy for glioma, but both diagnosis and handling are challenging. Due to the potential risks associated with RICE and its challenges in differentiating RICE from tumor progression, it is critical to better understand how RICE prognosis depends on iatrogenic influence.Materials and methods: We identified 99 patients diagnosed with RICE who were previously treated with either photon or proton therapy for World Health Organization (WHO) grade 1-3 primary gliomas. Post-treatment brain MRI-based volumetric analysis and clinical data collection was performed at multiple time points. Results: The most common histologic subtypes were astrocytoma (50%) and oligodendroglioma (46%). In 67%, it was graded WHO grade 2 and in 86% an IDH mutation was present. RICE first occurred after 16 months (range: 1-160) in median. At initial RICE occurrence, 39% were misinterpreted as tumor pro-gression. A tumor-specific therapy including chemotherapy or re-irradiation led to a RICE size progres-sion in 86% and 92% of cases, respectively and RICE symptom progression in 57% and 65% of cases, respectively. A RICE-specific therapy such as corticosteroids or Bevacizumab for larger or symptomatic RICE led to a RICE size regression in 81% of cases with symptom stability or regression in 62% of cases.Conclusions: While with chemotherapy and re-irradiation a RICE progression was frequently observed, anti-edematous or anti-VEGF treatment frequently went along with a RICE regression. For RICE, correct diagnosis and treatment decisions are challenging and critical and should be made interdisciplinarily.(c) 2022 Elsevier B.V. All rights reserved. Radiotherapy and Oncology 175 (2022) 133-143
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