Abstract
Temporal lobe necrosis (TLN) is the most debilitating late-stage complication after radiation therapy in patients with nasopharyngeal cancer (NPC). The bilateral temporal lobes are inevitably encompassed in the radiation field and are thus prone to radiation induced necrosis. The wide use of 3D conformal and intensity-modulated radiation therapy (IMRT) in the treatment of NPC has led to a dwindling incidence of TLN. Yet, it still holds great significance due to its incapacitating feature and the difficulties faced clinically and radiologically in distinguishing it from a malignancy. In this review, we highlight the evolution of different imaging modalities and therapeutic options. FDG PET, SPECT and Magnetic Spectroscopy are among the latest imaging tools that have been considered. In terms of treatment, Bevacizumab remains the latest promising breakthrough due to its ability to reverse the pathogenesis unlike conventional treatment options including large doses of steroids, anticoagulants, vitamins, hyperbaric oxygen and surgery.
Highlights
Nasopharyngeal cancer (NPC) is highly prevalent in Southern China, in Guangdong province and in the northern parts of Africa and Inuits of Alaska [1]
Treatment with radiation therapy under these circumstances exposes parts of the temporal lobes to doses over 60 Gy. This greatly increases the risks of temporal lobe necrosis (TLN) which is one of the most debilitating late stage complications after radiotherapy in NPC
Tsui et al used dynamic susceptibility contrast MRI to study the relative regional cerebral blood volume (rrCBV) of nine NPC after radiotherapy who presented with clinical features of temporal lobe necrosis [16]
Summary
Nasopharyngeal cancer (NPC) is highly prevalent in Southern China, in Guangdong province and in the northern parts of Africa and Inuits of Alaska [1]. The majority of radiation induced TLN patients with NPC that have been reported in the literature were Tsui et al used dynamic susceptibility contrast MRI to study the rrCBV of nine NPC after radiotherapy who presented with clinical features of temporal lobe necrosis [16].
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