目的:德国放射肿瘤学学会神经肿瘤学工作组(DEGRO;AGNRO)与德国癌症学会神经肿瘤学工作组(DKG-NOA)的成员合作,旨在定义诊断和治疗中枢神经系统(CNS)辐射诱发坏死(RN)的实用指南。
方法:DEGRO工作组的小组成员邀请专家,参加了一系列会议,补充了他们的临床经验,进行了文献综述,并制定了RN的医疗建议,包括贝伐单抗,在临床常规。
结论:RN的诊断和治疗需要多学科的护理结构和明确的流程。诊断必须在神经放射学家的共同知识的跨学科水平上进行,放射肿瘤学家,神经外科医生,神经病理学家,和神经肿瘤学家。如果可能诊断为血脑屏障破坏(BBD)或RN,应根据症状开始治疗,location,和动态的病变。有多种治疗选择(如观察、手术,类固醇,和贝伐单抗),最佳方法应在跨学科环境中讨论。在本实践指南中,我们为各种情况提供详细的治疗策略。
OBJECTIVE: The Working Group for Neurooncology of the German Society for Radiation Oncology (DEGRO; AG NRO) in cooperation with members of the Neurooncological Working Group of the German Cancer Society (DKG-NOA) aimed to define a practical
guideline for the diagnosis and treatment of radiation-induced necrosis (RN) of the central nervous system (CNS).
METHODS: Panel members of the DEGRO working group invited experts, participated in a series of conferences, supplemented their clinical experience, performed a literature review, and formulated recommendations for medical treatment of RN, including bevacizumab, in clinical routine.
CONCLUSIONS: Diagnosis and treatment of RN requires multidisciplinary structures of care and defined processes. Diagnosis has to be made on an interdisciplinary level with the joint knowledge of a neuroradiologist, radiation oncologist, neurosurgeon, neuropathologist, and neurooncologist. If the diagnosis of blood-brain barrier disruptions (BBD) or RN is likely, treatment should be initiated depending on the symptoms, location, and dynamic of the lesion. Multiple treatment options are available (such as observation, surgery, steroids, and bevacizumab) and the optimal approach should be discussed in an interdisciplinary setting. In this practice
guideline, we offer detailed treatment strategies for various scenarios.