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Journal Information
Vol. 33. Issue 4.
Pages 275-276 (May 2018)
Vol. 33. Issue 4.
Pages 275-276 (May 2018)
Letter to the Editor
DOI: 10.1016/j.nrleng.2015.11.021
Open Access
Comments on the review article «Cerebral radiation necrosis: Diagnostic challenge and clinical management»
Comentario al artículo de revisión «Necrosis cerebral por radiación: desafío diagnóstico y tratamiento clínico»
J.L. Gil-Salú
Servicio de Neurocirugía, Hospital Universitario Puerta del Mar, Cádiz, Spain
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Dear Editor:

I read with great interest the review article by Eisele and Dietrich1 on the exciting, little-understood subject of cerebral radiation necrosis secondary to surgical treatment for brain tumours.

The mechanisms involved in the physiopathogenesis of the condition are largely unknown; they may even vary with respect to the factors cited by authors as determinants: type of radiation, dose, treatment volume, and fractionation schedule. I would also like to add the type of supplementary treatment administered, which is normally chemotherapy, as mentioned in the review article.

The adjuvant chemotherapy used was different in each of the various studies establishing neuroradiological criteria over the past 3 decades.2–4 It is therefore admirable that other authors5 have attempted to compare the degree of correlation or concordance according to these criteria, in order to assess the type of progression, and suggest adding hyperintensity to FLAIR sequences to make contrast-enhanced sequences even more useful for assessing subsequent clinical worsening. We should also highlight that they compare treatments with the same adjuvant chemotherapy, in this case bevacizumab+irinotecan, which confers validity to the study and its results. Their main contribution was the inclusion of FLAIR sequence to the RECIST criteria (RECIST-F).

Based on the recruitment of a large number of patients from the AVAglio trial and after failing to demonstrate the usefulness of antiangiogenic therapy as a first line treatment after surgery in patients with glioblastoma, other authors also establish criteria to assess the response to this therapy and for this to be done uniformly.6

Our understanding of neuroradiology is expanding in parallel to the different surgical treatments and chemotherapies for patients with brain tumours. Although our gold standard continues to be anatomical pathology complemented by genetic/molecular techniques, advanced magnetic resonance imaging makes categorisation of tumours quicker and more reliable, which provides clarity in decision-making regarding these patients.

S.C. Eisele, J. Dietrich.
Necrosis cerebral por radiación: desafío diagnóstico y tratamiento clínico.
Rev Neurol, 61 (2015), pp. 225-232
D.R. Macdonald, T.L. Cascino, S.C. Schold Jr., J.G. Cairncross.
Response criteria for phase II studies of supratentorial malignant glioma.
J Clin Oncol, 8 (1990), pp. 1277-1280
E. Galanis, J.C. Buckner, M.J. Maurer, R. Sykora, R. Castillo, K.V. Ballman, Erickson for the North Central Cancer Treatment Group, et al.
Validation of neuroradiologic response assessment in gliomas: measurement by RECIST, two-dimensional, computer-assisted tumor area, and computer-assisted tumor volume methods.
Neuro Oncol, 8 (2006), pp. 156-165
P.Y. Wen, D.R. Macdonald, D.A. Reardon, T.F. Cloughesy, A.G. Sorensen, E. Galanis, et al.
Updated response assessment criteria for high-grade gliomas: response assessment in Neuro-Oncology working group.
J Clin Oncol, 28 (2010), pp. 1963-1972
J. Gállego Pérez-Larraya, M. Lahutte, G. Petrirena, G. Reyes-Botero, A. González-Aguilar, C. Houillier, et al.
Response assessment in recurrent glioblastoma treated with irinotecan-bevacizumab: comparative analysis of the Macdonald, RECIST, RANO, and RECIST+F criteria.
Neuro Oncol, 14 (2012), pp. 667-673
O.L. Chinot, D.R. Macdonald, E.L. Abrey, G. Zahlmann, Y. Kerloëguen, T.F. Cloughesy.
Response assessment criteria for glioblastoma: practical adaptation and implementation in clinical trials of antiangiogenic therapy.
Neurol Neurosci Rep, 13 (2013), pp. 347

Please cite this article as: Gil-Salú J. Comentario al artículo de revisión «Necrosis cerebral por radiación: desafío diagnóstico y tratamiento clínico». Neurología. 2018;33:275–276.

Copyright © 2015. Sociedad Española de Neurología
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