The European Association of Neuro-Oncology consensus statement on radiation necrosis
Year: 2026
Type: article
Abstract: BACKGROUND: Radiation necrosis (RN) complicates neuro-oncological care, mimicking tumor recurrence and lacking high-level evidence for standardized management. METHODS: A European Association of Neuro-Oncology (EANO) expert panel utilized a 3-round Delphi process to create a comprehensive expert opinion document based on the available current scientific evidence. A series of statements, derived from the published literature were created by the experts in each field. Consensus was defined as ≥80% agreement using a 5-point Likert scale. RESULTS: After 3 rounds among 20 experts that included adaptation of statements, the Delphi process reached a consensus (≥80% agreement) on 53 statements out of 57. RN occurs in 4%-30% of patients, typically appearing 6-24 months after radiotherapy for primary (glial) or metastatic brain tumors. Experts identified perfusion MRI and amino acid PET as the most suitable imaging modalities for differentiation from tumor recurrence. While histopathology remains the gold standard, identifying viable tumor cells in irradiated gliomas is challenging due to overlapping cytological features with reactive glia. For symptomatic management, corticosteroids may be tried, and bevacizumab is recommended for corticosteroid-refractory cases, with evidence suggesting profound efficacy even at low doses. Surgery is considered effective for rapid symptom relief and definitive diagnosis in accessible lesions. Laser Interstitial Thermal Therapy (LITT) can be considered an additional treatment option for symptomatic RN. CONCLUSIONS: Despite the absence of Level 1 evidence, these Delphi-survey-formulated recommendations provide actionable guidance for clinical practice. There is a need for prospective randomized trials focusing on symptomatic RN.
Source: Neuro-Oncology
Authors: Johnny Duerinck, Martin Van Den Bent, Petter Brandal, Giuseppe Minniti, Norbert Galldiks, Enrico Franceschi, Marjolein Geurts, Anna S Berghoff, Mirjam Renovanz, Dieta Brandsma, Tom J Snijders, Michael Weller, Susan C Short, Michael Platten, Emilie Le Rhun, Matthias Preusser, Leonille Schweizer, Nathalie Lisa Albert, Julia Furtner, Evangelia Razis
Institutions: Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Erasmus MC Cancer Institute, Oslo University Hospital, University of Oslo, Istituto Neurologico Mediterraneo, Sapienza University of Rome, Forschungszentrum Jülich, University Hospital Cologne, Istituto delle Scienze Neurologiche di Bologna, Medical University of Vienna, Universitätsklinikum Tübingen, University of Tübingen, The Netherlands Cancer Institute, Amsterdam University Medical Centers, University Medical Center Utrecht, University of Zurich, University Hospital Zurich, University of Leeds, Leeds Teaching Hospitals NHS Trust, German Cancer Research Center, Heidelberg University, University Medical Centre Mannheim, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt Cancer Institute, Deutsches Konsortium für Translationale Krebsforschung, LMU Klinikum, Ludwig-Maximilians-Universität München, Danube Private University, Universität für Weiterbildung Krems, Hygeia Hospital
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7167850986