Radiation Necrosis vs Tumor growth after 3 years

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December 20, 2013 at 12:12 pm  #1261145    


I did radiation therapy in spring of 2010. I had an onset of seizures in the fall of 2010 whereby it was suggested I had radiation necrosis (as opposed to tumor recurrence). MRI in March 2013 showed stability versus prior scans. In August 2013 my tumor had appeared to have grown versus scan in March 2013. In addition, swelling was now present. I have known about this tumor for over 20 years and during that time it has been very slow growing, but current change this year has been far greater. My doctor advised there was tumor enhancement as well, not previously seen ever. Can radiation necrosis show worsening after 3 years from radiation treatment? I know from reading that it is difficult to differentiate but wasn’t sure if 3 years is outside of the window of accelerating side effects. Thanks for any feedback.

December 20, 2013 at 1:17 pm  #1261146    
catdander forum moderator
catdander forum moderator

Hi walsh205, I’m sorry you’re having issues after this period of time. I did a search on Grace for radiation necrosis and found these results. http://cancergrace.org/search-results?q=radiation%20necrosis
The first one I read talked about a difference in brain tumors from metastases and those originated in the brain. Could you let us know which you’re dealing with. In the meantime I’ll ask our radiation oncologist to reply.

All the best,

December 20, 2013 at 2:07 pm  #1261147    

Dr Loiselle

Hi walsh205 –

Radiation necrosis (scarring) can evolve years after radiation treatment. The likelihood depends on many factors – the type of tumor treated, the size, the location, the radiation dose, and radiation technique.

Figuring out active tumor vs. scarring from prior treatment can be a complex problem, the likelihood of each dependent on all of the factors above.

At times, MR perfusion imaging or PET scans of the brain can help – however, both of these studies have limitations and often cannot readily identify necrosis vs. active tumor.

I hope that you have a good team of physicians providing you guidance on this…

Dr Loiselle

Chris Loiselle, MD
Radiation Oncologist
Swedish Cancer Institute

Views expressed here represent my opinion, not those of GRACE or Swedish Cancer Institute. This information does not constitute medical advice and is intended to supplement and not replace medical information provided by your doctor.

July 4, 2015 at 2:23 pm  #1270368    

My wife’s advocate

Dear Dr. Loiselle, I know this is somewhat an older post, but I have a pertinent question regarding the treatment of radiation necrosis. Is hyperbaric oxygen treatment a prefer method of choice over a chemo route say use of Avastin when steroid has not been able to control the edema from the necrosis?

Which one of the above mentioned treatment approach has the least potential bad side effect? Thank you in advance for your input and insight.

Wife, Asian non-smoker, 10/2010 left upper lobectomy, Diag: mod. diff. adenocarcinoma, focal squamous diff. with one AP node involvement. Dec 2010 thru Mar 2011 4 cycle cisplatin/vanorabin doublets completed. July 2011 MRI shown one 1.3 cm lesion with a 2.6 cm cystic component in rt. occipital region. Aug 2011 Neuro excision, confirmed sol. met from lung. Tested EGFR +. SRS irradiation on excision site 9/9/11, started Tarceva 9/26/11. Very difficult side effects. Tolerable after dose reduction to 100mg. Dec 2015 second brain surgery found life cancer cells in large bed of necrotic tissue. Feb-Mar 2016, 12 fractionized IMRT on right occipital lobe. Remain on Tarceva. Aug 2016 to Jun 2017 enlargement of pre-vascular lymph node from 1.4 to 2.2 cm. Mediastinotomy scheduled Sept 2017.

July 5, 2015 at 4:21 pm  #1270376    
catdander forum moderator
catdander forum moderator

Replied to here, http://cancergrace.org/topic/late-delayed-radiation-toxicity-or-side-effects-from-srs-on-excision-site#post-1270375

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