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Differentiation of Tumor Progression and Radiation-Induced Effects After Intracranial Radiosurgery

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Gamma Knife Neurosurgery in the Management of Intracranial Disorders

Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 116))

Abstract

A number of intracranial tumors demonstrate some degree of enlargement after stereotactic radiosurgery (SRS). It necessitates differentiation of their regrowth and various treatment-induced effects. Introduction of low-dose standards for SRS of benign neoplasms significantly decreased the risk of the radiation-induced necrosis after ­management of schwannomas and meningiomas. Although in such cases a transient increase of the mass volume within several months after irradiation is rather common, it usually followed by spontaneous shrinkage. Nevertheless, distinguishing tumor recurrence from radiation injury is often required in cases of malignant parenchymal brain neoplasms, such as metastases and gliomas. The diagnosis is frequently complicated by histopathological heterogeneity of the lesion with coexistent viable tumor and treatment-related changes. Several neuroimaging modalities, namely structural magnetic resonance imaging (MRI), diffusion-weighted imaging, diffusion tensor imaging, perfusion computed tomography (CT) and MRI, single-voxel and multivoxel proton magnetic resonance spectroscopy as well as single photon emission CT and positron emission tomography with various radioisotope tracers, may provide valuable diagnostic information. Each of these methods has advantages and limitations that may influence its usefulness and accuracy. Therefore, use of a multimodal radiological approach seems reasonable. Addition of functional and metabolic neuroimaging to regular structural MRI investigations during follow-up after SRS of parenchymal brain neoplasms may permit detailed evaluation of the treatment effects and early prediction of the response. If tissue sampling of irradiated intracranial lesions is required, it is preferably performed with the use of metabolic guidance. In conclusion, differentiation of tumor progression and radiation-induced effects after intracranial SRS is challenging. It should be based on a complex evaluation of the multiple clinical, radiosurgical, and radiological factors.

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Conflict of Interest

The authors declare that they have no conflict of interest. The research activities of Dr. Mikhail Chernov during 2010–2012 were supported by the Japan Society for the Promotion of Science (JSPS; ID No. P 10128).

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Authors and Affiliations

  1. Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Mikhail F. Chernov, Motohiro Hayashi, Yoshihiro Muragaki, Hiroshi Iseki & Kintomo Takakura

  2. Department of Neurosurgery, Neurological Institute, Tokyo Women’s Medical University, Tokyo, Japan

    Mikhail F. Chernov, Motohiro Hayashi, Yoshihiro Muragaki, Hiroshi Iseki & Kintomo Takakura

  3. Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women’s Medical University, Tokyo, Japan

    Yuko Ono, Kayoko Abe & Masao Usukura

  4. Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan

    Masahiro Izawa, Tomokatsu Hori & Yoshikazu Okada

  5. Radiosurgical Center, International Institute of the Biological Systems, Saint Petersburg, Russia

    Sergey V. Diment & Pavel I. Ivanov

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  12. Yoshikazu Okada
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  13. Kintomo Takakura
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Correspondence to Mikhail F. Chernov .

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Editors and Affiliations

  1. , Fac. of Adv. Techno-Surgery, Tokyo Women's Medical University, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Mikhail F. Chernov

  2. , Dept. of Neurosurgery, Tokyo Women's Medical University, Kawada-cho, Shinjuku-ku 8-1, Tokyo, 162-8666, Japan

    Motohiro Hayashi

  3. Oysteinsgate 16, Bergen, 5007, Norway

    Jeremy C. Ganz

  4. Kawada-cho, Shinjuku-ku 8-1, JP-162 8666 TOKYO, Japan

    Kintomo Takakura

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Chernov, M.F. et al. (2013). Differentiation of Tumor Progression and Radiation-Induced Effects After Intracranial Radiosurgery. In: Chernov, M., Hayashi, M., Ganz, J., Takakura, K. (eds) Gamma Knife Neurosurgery in the Management of Intracranial Disorders. Acta Neurochirurgica Supplement, vol 116. Springer, Vienna. https://doi.org/10.1007/978-3-7091-1376-9_29

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  • DOI: https://doi.org/10.1007/978-3-7091-1376-9_29

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  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-7091-1375-2

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