Cerebral radiation necrosis: a review of the pathobiology, diagnosis and management considerations

J Clin Neurosci. 2013 Apr;20(4):485-502. doi: 10.1016/j.jocn.2012.09.011. Epub 2013 Feb 14.


Radiation therapy forms one of the building blocks of the multi-disciplinary management of patients with brain tumors. Improved survival following radiation therapy may come with a cost, including the potential complication of radiation necrosis. Radiation necrosis impacts the quality of life in cancer survivors, and it is essential to detect and effectively treat this entity as early as possible. Significant progress in neuro-radiology and molecular pathology facilitate more straightforward diagnosis and characterization of cerebral radiation necrosis. Several therapeutic interventions, both medical and surgical, may halt the progression of radiation necrosis and diminish or abrogate its clinical manifestations, but there are still no definitive guidelines to follow explicitly that guide treatment of radiation necrosis. We discuss the pathobiology, clinical features, diagnosis, available treatment modalities, and outcomes in the management of patients with intracranial radiation necrosis that follows radiation used to treat brain tumors.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anticoagulants / therapeutic use
  • Antineoplastic Agents, Alkylating / therapeutic use
  • Blood-Brain Barrier
  • Brachytherapy / adverse effects
  • Brain Neoplasms / complications
  • Brain Neoplasms / radiotherapy
  • Brain Neoplasms / surgery
  • Carmustine / therapeutic use
  • Combined Modality Therapy
  • Humans
  • Hyperbaric Oxygenation
  • Magnetic Resonance Imaging
  • Necrosis / diagnosis
  • Necrosis / pathology*
  • Necrosis / therapy*
  • Radiation Injuries / diagnosis
  • Radiation Injuries / pathology*
  • Radiation Injuries / therapy*
  • Radiosurgery / adverse effects*
  • Radiotherapy / adverse effects*
  • Steroids / therapeutic use
  • Tomography, X-Ray Computed


  • Anticoagulants
  • Antineoplastic Agents, Alkylating
  • Steroids
  • Carmustine