Radionecrosis in Gliomas: The Diagnostic and Therapeutic Challenge: A Narrative Review

Glioma treatment primarily involves maximum safe resection, although complete tumor removal is often unfeasible due to its invasive nature and proximity to vital brain areas. Consequently, surgery is typically complemented by chemotherapy and/or radiotherapy to enhance patient survival. However, radiotherapy and radiosurgery can result in radionecrosis, a complication characterized by necrotic tissue and fibrinous exudate near the irradiated cerebral glial lesion’s edge. This condition is challenging to differentiate from tumor progression using conventional imaging techniques. To address this issue, innovative imaging methods, including specific magnetic resonance imaging sequences and PET tracers, have been scientifically validated to improve radionecrosis detection. While these tools offer good sensitivity and specificity, they may yield false positives. Accurate lesion identification is crucial for determining appropriate treatment strategies. Patients with radiation necrosis may receive conservative treatments such as corticosteroids, bevacizumab, or other medications, while surgical excision is generally reserved for symptomatic cases unresponsive to drug therapy. Thus, distinguishing between tumor progression and radiation necrosis remains a significant clinical challenge in glioma management.