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Case Report

Differentiation of radiation necrosis from

glioblastoma recurrence after radiotherapy

Chrissa Sioka , Anastasia Zikou , Anna Goussia , Spyridon Tsiouris , Loucas G. Astrakas ,
4
2
3
1
2
Athanassios P. Kyritsis 1,5
1 Neurosurgical Institute, University of Ioannina, 45500 Ioannina, Greece.
2 Department of Radiology, University Hospital of Ioannina, 45500 Ioannina, Greece.
3 Department of Pathology, University Hospital of Ioannina, 45500 Ioannina, Greece.
4 Department of Nuclear Medicine, University Hospital of Ioannina, 45500 Ioannina, Greece.
5 Department of Neurology, University Hospital of Ioannina, 45500 Ioannina, Greece.

Dr. Chrissa Sioka, M.D., D.Sci., received her M.D. in 1998 from the University of Sofia Medical School
in Sofia, Bulgaria, and her D.Sci. from the University of Ioannina, Greece. She finished her Nuclear
Medicine Residency in 2007. Her research is focusing on imaging techniques using single photon
emission computed tomography and positron emission tomography.

A B S T R AC T

The standard treatment of glioblastoma, the most common type of primary-brain-tumor, involves radiotherapy with concomitant
temozolomide chemotherapy. A patient with glioblastoma, post radiotherapy developed magnatic resonance imaging (MRI) changes
consistent with either radiation-induced tumor necrosis or tumor recurrence. Perfusion MRI was suggestive of radiation necrosis,
but magnetic resonance spectroscopy and 99m Tc-Tetrofosmin single photon emission computed tomography was indicative of tumor
recurrence. Positron emission tomography scan was not available. Tumor recurrence was documented by biopsy. Several advanced
imaging methods are available to differentiate tumor recurrence from radiation necrosis in glioblastoma patients. However, in
inconclusive cases, brain biopsy should be performed for definite diagnosis.
Key words: Glioblastoma multiforme; single photon emission computed tomography; magnatic resonance imaging; spectroscopy;
radiotherapy

INTRODUCTION to treat, exhibiting high recurrence rates and poor
survival. The initial therapeutic intervention involves
[2]
Glioblastoma multiforme (GBM) is the most frequent maximal surgical resection, if the tumor is surgically
primary-brain-tumor in adults. Its profound cellular accessible, otherwise a needle biopsy, to document the
heterogeneity, presence of stem cells and highly diagnosis and determine the histologic grade, suffices.
invasive characteristics renders this tumor difficult The mainstay of post-surgical therapy involves
[1]
conventional radiotherapy, with an approximate
Corresponding Author: Dr. Chrissa Sioka, Neurosurgical
Institute, University of Ioannina, 45500 Ioannina, Greece. This is an open access article distributed under the terms of the Creative
E-mail: csioka@yahoo.com Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows
others to remix, tweak, and build upon the work non-commercially, as long as the
Access this article online author is credited and the new creations are licensed under the identical terms.
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Website:
http://www.nnjournal.net
How to cite this article: Sioka C, Zikou A, Goussia A, Tsiouris
S, Astrakas LG, Kyritsis AP. Differentiation of radiation necrosis
from glioblastoma recurrence after radiotherapy. Neuroimmunol
DOI: 10.20517/2347-8659.2016.08 Neuroinflammation 2016;3:161-4.
Received: 09-02-2016; Accepted: 12-04-2016
© 2016 Neuroimmunology and Neuroinflammation | Published by OAE Publishing Inc. 161