Radiotherapy and Radionecrosis in Glioma Treatment

Gizem KAVAKa, Yıldız GÜNEYa

aAnkara Etlik City Hospital, Clinic of Radiation Oncology, Ankara, Türkiye

Kavak G, Güney Y. Radiotherapy and ra- dionecrosis in glioma treatment. In: Uğur HÇ, Bayatlı E, eds. Glial Tumours: Expectations from Today-Promises of the Future. 1st ed. An- kara: Türkiye Klinikleri; 2024. p.63-8.

ABSTRACT

The treatment results of glial tumors are still not very satisfactory. The diagnosis, treatment and follow- up of this disease require multidisciplinary teamwork. When diagnosing the disease, it is very important to perform the necessary radiological examinations completely before surgery. This facilitates both surgical resection and radiother- apy to be added after surgery. As a first step, the surgical team should perform as complete resection of the tumor as possible. Complete resection is very important for the success of the treatment. Any residuals should be detected with radiological examinations to be repeated after surgery. Radiotherapy to be given afterwards continues to be an integral part of the treatment. Systemic agents added also increase the effectiveness of radiotherapy. During treatment, it is of great importance to regularly follow up the patient and find solutions to the symptoms that may develop due to radio- therapy or chemotherapy for the patient’s compliance with and continuation of treatment. Regular follow-up is recom- mended for patients after treatment; it is of great importance to distinguish recurrence, pseudoprogression and radionecrosis that may develop during follow-up with a good radiological team and to manage these processes cor- rectly. Pseudoprogression diagnosis can be made by continuing follow-up and systemic treatment and stabilizing or re- gressing the findings. Second-line local treatments can be considered in patients with suspected recurrence. These include re-surgery or secondary irradiation. Stereotactic radiosurgery or fractionated stereotactic radiotherapy is usu- ally added as secondary irradiation. Second/third-line chemotherapy can be considered by medical oncology as systemic treatment. Radionecrosis continues to be a serious toxicity that can develop within 1-3 years after treatment. While no additional recommendations are generally made to asymptomatic patients, various medical agents can be added to symptomatic patients. As we mentioned earlier, studies are ongoing because survival results in glioblastoma treatment are not satisfactory enough. Among the new technological developments, artificial intelligence seems to be involved in the disease and treatment process in many areas such as diagnosis and treatment. With the developments in new gen- eration DNA sequencing systems, individualized treatments seem to occupy the agenda in glioblastoma treatment as in every stage of medical science. In this part of the study, radiotherapy in glial tumors, radiotherapy techniques, pseudo- progression that may develop during follow-up, radionecrosis, recurrence situations and what may await us in the fu- ture with developing technology are discussed.

Keywords: Glial tumour; radiotherapy; reirradiation; pseudoprogression; radionecrosis; recurrence

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