TY - JOUR
T1 - Brain radiation necrosis
T2 - Current management with a focus on non-small cell lung cancer patients
AU - Loganadane, Gokoulakrichenane
AU - Dhermain, Frédéric
AU - Louvel, Guillaume
AU - Kauv, Paul
AU - Deutsch, Eric
AU - Le Péchoux, Cécile
AU - Levy, Antonin
N1 - Publisher Copyright:
© 2018 Loganadane, Dhermain, Louvel, Kauv, Deutsch, Le Péchoux and Levy.
PY - 2018/9/5
Y1 - 2018/9/5
N2 - As the prognosis of metastatic non-small cell lung cancer (NSCLC) patients is constantly improving with advances in systemic therapies (immune checkpoint blockers and new generation of targeted molecular compounds), more attention should be paid to the diagnosis and management of treatments-related long-term secondary effects. Brain metastases (BM) occur frequently in the natural history of NSCLC and stereotactic radiation therapy (SRT) is one of the main efficient local non-invasive therapeutic methods. However, SRT may have some disabling side effects. Brain radiation necrosis (RN) represents one of the main limiting toxicities, generally occurring from 6 months to several years after treatment. The diagnosis of RN itself may be quite challenging, as conventional imaging is frequently not able to differentiate RN from BM recurrence. Retrospective studies have suggested increased incidence rates of RN in NSCLC patients with oncogenic driver mutations [epidermal growth factor receptor (EGFR) mutated or anaplastic lymphoma kinase (ALK) positive] or receiving tyrosine kinase inhibitors. The risk of immune checkpoint inhibitors in contributing to RN remains controversial. Treatment modalities for RN have not been prospectively compared. Those include surveillance, corticosteroids, bevacizumab and local interventions (minimally invasive laser interstitial thermal ablation or surgery). The aim of this review is to describe and discuss possible RN management options in the light of the newly available literature, with a particular focus on NSCLC patients.
AB - As the prognosis of metastatic non-small cell lung cancer (NSCLC) patients is constantly improving with advances in systemic therapies (immune checkpoint blockers and new generation of targeted molecular compounds), more attention should be paid to the diagnosis and management of treatments-related long-term secondary effects. Brain metastases (BM) occur frequently in the natural history of NSCLC and stereotactic radiation therapy (SRT) is one of the main efficient local non-invasive therapeutic methods. However, SRT may have some disabling side effects. Brain radiation necrosis (RN) represents one of the main limiting toxicities, generally occurring from 6 months to several years after treatment. The diagnosis of RN itself may be quite challenging, as conventional imaging is frequently not able to differentiate RN from BM recurrence. Retrospective studies have suggested increased incidence rates of RN in NSCLC patients with oncogenic driver mutations [epidermal growth factor receptor (EGFR) mutated or anaplastic lymphoma kinase (ALK) positive] or receiving tyrosine kinase inhibitors. The risk of immune checkpoint inhibitors in contributing to RN remains controversial. Treatment modalities for RN have not been prospectively compared. Those include surveillance, corticosteroids, bevacizumab and local interventions (minimally invasive laser interstitial thermal ablation or surgery). The aim of this review is to describe and discuss possible RN management options in the light of the newly available literature, with a particular focus on NSCLC patients.
KW - Complication
KW - Immunotherapy
KW - Lung cancer
KW - Radiosurgery
KW - Stereotactic radiotherapy
KW - Vascular endothelial growth factor (VEGF)
UR - http://www.scopus.com/inward/record.url?scp=85053167856&partnerID=8YFLogxK
U2 - 10.3389/fonc.2018.00336
DO - 10.3389/fonc.2018.00336
M3 - Short survey
AN - SCOPUS:85053167856
SN - 2234-943X
VL - 8
JO - Frontiers in Oncology
JF - Frontiers in Oncology
IS - SEP
M1 - 336
ER -