|
Typical treatment for brain radionecrosis usually begins when the
patient first becomes symptomatic. It involves initial medical management
and then, for patients showing continued progression of injury,
surgical excision of the avascular necrotic tissue.
|
 |
|
Corticosteroids are usually initiated as the first stage of medical
management in an attempt to stabilize or improve the neurologic
symptoms.18,20,62,65 Corticosteroids have been shown
to reduce cerebral edema in patients with brain radionecrosis.18,65,66
|
|
The mechanism of action for steroid treatment is, like the injury,
not well established, but has been linked to decreased vascular
permeability, reduction in inflammation, attenuation of lipid peroxidation,
normalization of electrolyte imbalances in the edematous brain,
and improved metabolic function.5,13,38,95,111,113,114
|
|
|
For patients who are unresponsive to initial steroid therapy, conventional
practice has been to increase the steroid dosage. The dosage is
continually increased until the symptoms of brain radionecrosis
are stabilized or controlled. In one study, 65% of patients had to
have their steroid levels continually increased in a failing attempt
to mitigate deteriorating clinical status and progressive neurologic
injury.58 This course of treatment has a devastating
limitation in that the steroid regimen becomes excessive (e.g., more
than 20 mg of dexamethasone [Decadron] daily). These high doses
of corticosteroids cannot be continued long term without significantly
increasing the risk of morbidity, with complications arising such as:
• gastrointestinal bleeding
• glucose intolerance
• immunosuppression
• neuropsychiatric disturbances
• weight gain
• weakness
• distortion of body habitus38,93,111
|
