Delayed radiation-induced vasculitic leukoencephalopathy.

摘要: Purpose Recently, single-fraction, high-dosed focused radiation therapy such as that administered by Gamma Knife radiosurgery has been used increasingly for the treatment of metastatic brain cancer. Radiation to can cause delayed leukoencephalopathy, which carries its own significant morbidity and mortality. While radiosurgery-induced leukoencephalopathy is known be clinically different from following fractionated radiation, pathological differences are not well characterized. In this study, we aimed integrate novel radiographic histopathologic observations gain a conceptual understanding leukoencephalopathy. Methods Materials We examined resected tissues 10 patients treated at Yale New Haven Hospital between January 1, 2009, June 30, 2010, metastases had previously with radiosurgery, who subsequently required surgical management symptomatic regrowing lesion. None showed evidence tumor recurrence. Clinical magnetic resonance imaging data each were then studied retrospectively. Results provide show may present an advancing process extends beyond original high-dose field. Neuropathologic examination tissue revealed traditionally leukoencephalopathic changes including demyelination, coagulation necrosis, vascular sclerosis. Unexpectedly, small medium-sized vessels transmural T-cell infiltration indicative active vasculitis. Conclusions propose presence vasculitic component in association radiation-induced facilitate progressive nature condition. It also explain resemblance recurring on virtually all modalities posttreatment follow-up.