Radiation Necrosis

[jimy__0]

  My wife had a resection of an Anaplastic Astrocytoma Grade III in 1996. She underwent maximum dose of radiation and CCNU. In October of 1998 during our three month check up the doctor told us that there were two lesions discovered on top of the old tumor site. He ordered another MRI with the contrast in a push and he determined that it was necrosis instead of recurrence. He started my wife on 200 mg Accutane per day for 21 days and the 7 days off and another 21 days on. Since she started this treatment her left arem and leg have become very weak and she cannot walk. She is scheduled to have a PET scan asap. I contacted the doctor tonight and he started her on 4 mg Decadron 3 times a day for swelling in the brain from the Accutane. My fear is that she might have had a stroke. I also tried to do research on Radiation Necrosis with little help on its side effects. Any information you can provide will be helpful. Thanks!
Dear Jimmy,
Injury to the brain from radiation necrosis can occur 3months to 3years after the radiation.  Structures adjacent to the area of tumor resection undergo necrosis.  In some, areas the brain tissue softens and liquifies forming a caviatation.  Lesser degress of injury include demylinating ( the nerves lose their covering that helps conduction of nerve signals).  When changes occur they may present as a slowly evolving mass, difficult to separate from  tumor growth, or a dementia (mental status change).  The clinical pattern varies depending on the site of the original lesion( depending on the original site and evolution of symptoms, this may be responsible for the weakness).  In the production of radiation necrosis, the dose and time over which it is given is important, however, the exact amounts that produce such damage cannot be stated.  CT or MRI  may help distiguish tumor from radiation necrosis, however, but PET or SPECT scan are the more reliable choices.  Treatment usually consists of steroids which may cause regression of symptoms and surrounding edema.  Surgery has yeilded mixed results.  Discuss these options with your doctor.  If ever you are interested in getting an evaluation at CCF, call 1-800-CCF-CARE.  Good Luck.