Abstract
Cerebral radiation necrosis (CRN) is one of the most prominent sequelae following radiation therapy for nasopharyngeal carcinoma (NPC), which might have devastating effects on patients’ quality of life (QOL). Advances in histopathology and neuro-radiology have shed light on the management of CRN more comprehensively, yet effective therapeutic interventions are still lacking. CRN was once regarded as progressive and irreversible, however, in the past 20 years, with the application of intensity-modulated radiation therapy (IMRT), both the incidence and severity of CRN have declined. In addition, newly developed medical agents including bevacizumab-a humanized monoclonal antibody against vascular endothelial growth factor (VEGF), nerve growth factor (NGF), monosialotetrahexosylganglioside (GM1), etc., have shown great potency in successfully reversing radiation-induced CRN. As temporal lobes are most frequently compromised in NPC patients, this review will summarize the state-of-the-art progress regarding the incidence, pathophysiology, prevention, treatment, and prognosis of temporal lobe necrosis (TLN) after IMRT in NPC.
Highlights
Nasopharyngeal carcinoma (NPC) constitutes the largest proportion of head and neck malignancies in China and Southeast-Asia, and radiation therapy (RT) is the mainstay treatment for non-metastatic cases
The impact of targeted agents on temporal lobe necrosis (TLN) is yet uncertain, but some studies have suggested that cetuximab, a monoclonal antibody to epidermal growth factor receptor (EGFR), might confer relatively high risk of TLN when used concurrently with RT in both treatment-naïve and recurrent nasopharyngeal carcinoma (NPC) patients [6, 7]
Currently the most widely accepted dose constraint is the recommendation from Radiation Therapy Oncology Group (RTOG) 0225, which confined the maximum dose (Dmax) to lower than 60 Gy and 1% of the temporal lobe volume not exceeding 65 Gy [26]
Summary
Temporal Lobe Necrosis Following Radiotherapy in Nasopharyngeal Carcinoma: New Insight Into the Management. Cerebral radiation necrosis (CRN) is one of the most prominent sequelae following radiation therapy for nasopharyngeal carcinoma (NPC), which might have devastating effects on patients’ quality of life (QOL). Advances in histopathology and neuro-radiology have shed light on the management of CRN more comprehensively, yet effective therapeutic interventions are still lacking. CRN was once regarded as progressive and irreversible, in the past 20 years, with the application of intensity-modulated radiation therapy (IMRT), both the incidence and severity of CRN have declined. As temporal lobes are most frequently compromised in NPC patients, this review will summarize the state-of-the-art progress regarding the incidence, pathophysiology, prevention, treatment, and prognosis of temporal lobe necrosis (TLN) after IMRT in NPC
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