Recurrent glioma and radiation necrosis: a meta-analysis of MRI diagnosis

Abstract BACKGROUND It is challenging to discriminate radiation necrosis from tumor progression, especially in malignant glioma. Therefore many radiological imaging studies have been reported. In this study, we performed a systematic review of radiological diagnosis for radiation necrosis and analyzed the best radiological imaging for malignant glioma. METHODS We divided diagnostic approaches into two categories as follows-CT and MRI (conventional radiological imaging studies), and SPECT and PET (nuclear medicine studies). Our librarians conducted a comprehensive systematic search on Pub Med, Cochrane Library, and the Japan Medical Abstract Society up to March 2015. The searching keywords included radiation necrosis, recurrence, imaging modalities such as MRI, diagnosis, and differential. In a meta-analysis, diagnostic odds ratio (DOR) was calculated. A subanalysis was performed, dividing into tumor types, gliomas and metastatic brain tumors. RESULTS Of 188 and 239 records extracted from the database, 20 and 26 studies were included in the meta-analysis after exclusion of case reports and studies with incompatible content and insufficient information. Gd-enhanced MRI exhibited the lowest sensitivity (63%) and DOR (2.2). On the other hand, combined multiple imaging studies including MRS and perfusion image displayed the highest sensitivity (96%) and DOR (5.9). In the subanalysis for glioma, Gd-enhanced MRI and 18F-FDG-PET revealed low DORs (1.7 and 2.3). Conversely, 18F-FET-PET and combined multiple imaging studies showed high DORs (6.8 and 5.9). CONCLUSIONS Gd-enhanced MRI had low diagnostic ability for differentiation of radiation necrosis. In glioma patients, 18F-FDG-PET was not useful to discriminate radiation necrosis from tumor progression. Combined multiparametric imaging including lesional metabolism and blood flow could enhance diagnostic accuracy and be useful to differentiate radiation necrosis from tumor progression even in glioma patients.

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Diagnostic Accuracy of PET for Recurrent Glioma Diagnosis: A Meta-Analysis

American Journal of Neuroradiology ◽

10.3174/ajnr.a3324 ◽

2012 ◽

Vol 34 (5) ◽

pp. 944-950 ◽

Cited By ~ 88

Author(s):

T. Nihashi ◽

I.J. Dahabreh ◽

T. Terasawa

Keyword(s):

Diagnostic Accuracy ◽

Meta Analysis ◽

Recurrent Glioma

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Comparison of 18F-Fluorodeoxyglucose and 18F-Fluorothymidine PET in Differentiating Radiation Necrosis From Recurrent Glioma

Clinical Nuclear Medicine ◽

10.1097/rlu.0b013e318262c76a ◽

2012 ◽

Vol 37 (9) ◽

pp. 854-861 ◽

Cited By ~ 36

Author(s):

Michael S. Enslow ◽

Lauren V. Zollinger ◽

Kathryn A. Morton ◽

Regan I. Butterfield ◽

Dan J. Kadrmas ◽

...

Keyword(s):

Radiation Necrosis ◽

Recurrent Glioma ◽

18F Fluorodeoxyglucose

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Accuracy of MRI diagnosis of early osteonecrosis of the femoral head: a meta-analysis and systematic review

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-018-0836-8 ◽

2018 ◽

Vol 13 (1) ◽

Cited By ~ 7

Author(s):

Ya-Zhou Zhang ◽

Xu-Yang Cao ◽

Xi-Cheng Li ◽

Jia Chen ◽

Yue-Yuan Zhao ◽

...

Keyword(s):

Systematic Review ◽

Femoral Head ◽

Meta Analysis ◽

Mri Diagnosis

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RADI-14. Bevacizumab vs Laser Interstitial Thermal Therapy in radiation necrosis from brain metastases: a systematic review and meta-analysis

Neuro-Oncology Advances ◽

10.1093/noajnl/vdab071.084 ◽

2021 ◽

Vol 3 (Supplement_3) ◽

pp. iii20-iii21

Author(s):

Paolo Palmisciano ◽

Ali S Haider ◽

Chibueze D Nwagwu ◽

Waseem Wahood ◽

Navraj S Sagoo ◽

...

Keyword(s):

Brain Metastases ◽

Radiation Necrosis ◽

Meta Analysis ◽

Statistical Significance ◽

Treatment Options ◽

Random Effect ◽

Survival Rates ◽

Treatment Strategies ◽

Thermal Therapy ◽

Laser Interstitial Thermal Therapy

Abstract Objective Radiation necrosis (RN) represents a serious post-radiotherapy complication in patients with brain metastases. Bevacizumab and laser interstitial thermal therapy (LITT) are viable treatment options, but direct comparative data is scarce. We reviewed the literature to compare the two treatment strategies. Methods PubMed, EMBASE, Scopus, and Cochrane databases were searched. All studies of patients with RN from brain metastases treated with bevacizumab or LITT were included. Treatment outcomes were analyzed using indirect meta-analysis with random-effect modeling. Results Among the 18 studies included, 143 patients received bevacizumab and 148 underwent LITT. Both strategies were equally effective in providing post-treatment symptomatic improvement (P=0.187, I2=54.8%), weaning off steroids (P=0.614, I2=25.5%), and local lesion control (P=0.5, I2=0%). The mean number of lesions per patient was not statistically significant among groups (P=0.624). Similarly, mean T1-contrast-enhancing pre-treatment volumes were not statistically different (P=0.582). Patterns of radiological responses differed at 6-month follow-ups, with rates of partial regression significantly higher in the bevacizumab group (P=0.001, I2=88.9%), and stable disease significantly higher in the LITT group (P=0.002, I2=81.9%). Survival rates were superior in the LITT cohort, and statistical significance was reached at 18 months (P=0.038, I2=73.7%). Low rates of adverse events were reported in both groups (14.7% for bevacizumab and 12.2% for LITT). Conclusion Bevacizumab and LITT can be safe and effective treatments for RN from brain metastases. Clinical and radiological outcomes are mostly comparable, but LITT may relate to superior survival benefits in select patients. Further studies are required to identify the best patient candidates for each treatment group.

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Bevacizumab for radiation necrosis following radiotherapy of brain metastatic disease: a systematic review & meta-analysis

BMC Cancer ◽

10.1186/s12885-021-07889-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Muhammad Khan ◽

Zhihong Zhao ◽

Sumbal Arooj ◽

Guixiang Liao

Keyword(s):

Systematic Review ◽

Monoclonal Antibody ◽

Random Effects ◽

Metastatic Disease ◽

Radiation Necrosis ◽

Meta Analysis ◽

Cochrane Library ◽

Random Effects Model ◽

Efficacy And Safety ◽

Radiographic Response

Abstract Background Radiotherapy is the mainstay of brain metastasis (BM) management. Radiation necrosis (RN) is a serious complication of radiotherapy. Bevacizumab (BV), an anti-vascular endothelial growth factor monoclonal antibody, has been increasingly used for RN treatment. We systematically reviewed the medical literature for studies reporting the efficacy and safety of bevacizumab for treatment of RN in BM patients. Materials and methods PubMed, Medline, EMBASE, and Cochrane library were searched with various search keywords such as “bevacizumab” OR “anti-VEGF monoclonal antibody” AND “radiation necrosis” OR “radiation-induced brain necrosis” OR “RN” OR “RBN” AND “Brain metastases” OR “BM” until 1st Aug 2020. Studies reporting the efficacy and safety of BV treatment for BM patients with RN were retrieved. Study selection and data extraction were carried out by independent investigators. Open Meta Analyst software was used as a random effects model for meta-analysis to obtain mean reduction rates. Results Two prospective, seven retrospective, and three case report studies involving 89 patients with RN treated with BV were included in this systematic review and meta-analysis. In total, 83 (93%) patients had a recorded radiographic response to BV therapy, and six (6.7%) had experienced progressive disease. Seven studies (n = 73) reported mean volume reductions on gadolinium-enhanced T1 (mean: 47.03%, +/− 24.4) and T2-weighted fluid-attenuated inversion recovery (FLAIR) MRI images (mean: 61.9%, +/− 23.3). Pooling together the T1 and T2 MRI reduction rates by random effects model revealed a mean of 48.58 (95% CI: 38.32–58.85) for T1 reduction rate and 62.017 (95% CI: 52.235–71.799) for T2W imaging studies. Eighty-five patients presented with neurological symptoms. After BV treatment, nine (10%) had stable symptoms, 39 (48%) had improved, and 34 (40%) patients had complete resolution of their symptoms. Individual patient data was available for 54 patients. Dexamethasone discontinuation or reduction in dosage was observed in 30 (97%) of 31 patients who had recorded dosage before and after BV treatment. Side effects were mild. Conclusions Bevacizumab presents a promising treatment strategy for patients with RN and brain metastatic disease. Radiographic response and clinical improvement was observed without any serious adverse events. Further class I evidence would be required to establish a bevacizumab recommendation in this group of patients.

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