Abstract：
Radionecrosis is a common complication in radiation oncology, while mechanisms and risk factors have yet to be fully explored. We therefore conducted a systematic review to understand the pathogenesis and identify factors that significantly affect the development.
We performed a systematic literature search based on the PRISMA guidelines using PubMed, Ovid, and Web of Science databases. The complete search strategy can be found as a preregistered protocol on PROSPERO (CRD42023361662).
We included 83 studies, most involving healthy animals (n = 72, 86.75 %). High doses of hemispherical irradiation of 30 Gy in rats and 50 Gy in mice led repeatedly to radionecrosis among different studies and set-ups. Higher dose and larger irradiated volume were associated with earlier onset. Fractionated schedules showed limited effectiveness in the prevention of radionecrosis. Distinct anatomical brain structures respond to irradiation in various ways. White matter appears to be more vulnerable than gray matter. Younger age, more evolved animal species, and genetic background were also significant factors, whereas sex was irrelevant. Only 13.25 % of the studies were performed on primary brain tumor bearing animals, no studies on brain metastases are currently available.
This systematic review identified various factors that significantly affect the induction of radionecrosis. The current state of research neglects the utilization of animal models of brain tumors, even though patients with brain malignancies constitute the largest group receiving brain irradiation. This latter aspect should be primarily addressed when developing an experimental radionecrosis model for translational implementation.
We performed a systematic literature search based on the PRISMA guidelines using PubMed, Ovid, and Web of Science databases. The complete search strategy can be found as a preregistered protocol on PROSPERO (CRD42023361662).
We included 83 studies, most involving healthy animals (n = 72, 86.75 %). High doses of hemispherical irradiation of 30 Gy in rats and 50 Gy in mice led repeatedly to radionecrosis among different studies and set-ups. Higher dose and larger irradiated volume were associated with earlier onset. Fractionated schedules showed limited effectiveness in the prevention of radionecrosis. Distinct anatomical brain structures respond to irradiation in various ways. White matter appears to be more vulnerable than gray matter. Younger age, more evolved animal species, and genetic background were also significant factors, whereas sex was irrelevant. Only 13.25 % of the studies were performed on primary brain tumor bearing animals, no studies on brain metastases are currently available.
This systematic review identified various factors that significantly affect the induction of radionecrosis. The current state of research neglects the utilization of animal models of brain tumors, even though patients with brain malignancies constitute the largest group receiving brain irradiation. This latter aspect should be primarily addressed when developing an experimental radionecrosis model for translational implementation.
摘要：
背景：放射性坏死是放射肿瘤学的常见并发症，而机制和风险因素还有待充分探索。因此，我们进行了系统评价，以了解发病机理并确定显着影响发育的因素。
方法：我们根据PRISMA指南使用PubMed，奥维德,和WebofScience数据库。完整的搜索策略可以作为PROSPERO（CRD42023361662）上的预注册协议找到。
结果：我们纳入了83项研究，大多数涉及健康动物(n=72，86.75%)。在不同的研究和设置中，大鼠30Gy和小鼠50Gy的高剂量半球形辐射反复导致放射性坏死。较高的剂量和较大的照射体积与较早的发作有关。分割的时间表证明在预防放射性坏死方面的有效性有限。不同的解剖脑结构以各种方式响应于照射。白质似乎比灰质更脆弱。年龄更小,更多进化的动物物种，遗传背景也是重要因素，而性是无关紧要的。只有13.25%的研究是在携带原发性脑瘤的动物身上进行的，目前尚无关于脑转移的研究.
结论：本系统综述确定了显著影响放射性坏死诱导的各种因素。目前的研究状况忽视了脑肿瘤动物模型的应用,即使患有脑恶性肿瘤的患者构成了接受脑照射的最大群体。在开发用于翻译实现的实验性放射性坏死模型时，应主要解决后一个方面。
方法：我们根据PRISMA指南使用PubMed，奥维德,和WebofScience数据库。完整的搜索策略可以作为PROSPERO（CRD42023361662）上的预注册协议找到。
结果：我们纳入了83项研究，大多数涉及健康动物(n=72，86.75%)。在不同的研究和设置中，大鼠30Gy和小鼠50Gy的高剂量半球形辐射反复导致放射性坏死。较高的剂量和较大的照射体积与较早的发作有关。分割的时间表证明在预防放射性坏死方面的有效性有限。不同的解剖脑结构以各种方式响应于照射。白质似乎比灰质更脆弱。年龄更小,更多进化的动物物种，遗传背景也是重要因素，而性是无关紧要的。只有13.25%的研究是在携带原发性脑瘤的动物身上进行的，目前尚无关于脑转移的研究.
结论：本系统综述确定了显著影响放射性坏死诱导的各种因素。目前的研究状况忽视了脑肿瘤动物模型的应用,即使患有脑恶性肿瘤的患者构成了接受脑照射的最大群体。在开发用于翻译实现的实验性放射性坏死模型时，应主要解决后一个方面。
