Challenges with the diagnosis and treatment of cerebral radiation necrosis

Int J Radiat Oncol Biol Phys. 2013 Nov 1;87(3):449-57. doi: 10.1016/j.ijrobp.2013.05.015. Epub 2013 Jun 19.


The incidence of radiation necrosis has increased secondary to greater use of combined modality therapy for brain tumors and stereotactic radiosurgery. Given that its characteristics on standard imaging are no different that tumor recurrence, it is difficult to diagnose without use of more sophisticated imaging and nuclear medicine scans, although the accuracy of such scans is controversial. Historically, treatment had been limited to steroids, hyperbaric oxygen, anticoagulants, and surgical resection. A recent prospective randomized study has confirmed the efficacy of bevacizumab in treating radiation necrosis. Novel therapies include using focused interstitial laser thermal therapy. This article will review the diagnosis and treatment of radiation necrosis.

Publication types

  • Review

MeSH terms

  • Algorithms
  • Animals
  • Antibodies, Monoclonal, Humanized / therapeutic use
  • Bevacizumab
  • Brain / pathology*
  • Brain / radiation effects
  • Brain Neoplasms / surgery*
  • Humans
  • Intracranial Arteriovenous Malformations / radiotherapy
  • Magnetic Resonance Imaging
  • Necrosis / diagnosis
  • Necrosis / etiology
  • Necrosis / therapy
  • Positron-Emission Tomography
  • Radiation Injuries / diagnosis*
  • Radiation Injuries / pathology
  • Radiation Injuries / therapy*
  • Radiosurgery / adverse effects*
  • Rats
  • Steroids / therapeutic use


  • Antibodies, Monoclonal, Humanized
  • Steroids
  • Bevacizumab