How do you manage asymptomatic radiation necrosis in a glioblastoma?

If a patient is not symptomatic from radiation necrosis, the only thing that would make me consider initiation of dexamethasone (Consideration of Avastin reserved for symptoms refractory to steroids) would be significant midline shift that is progressing, but this is usually going to lead to symptom...

Follow the patient and see what happens.

Most rad oncs are unaware of the role Hyperbaric oxygen can play in helping to resuscitate the radiation damaged cells in the ischemic penumbra around a core of dead brain cells. SPECT or PET scanning can both demonstrate the area we are talking about. It is the area wherein some healing can be anti...

A. Observation if RN is small and asymptomatic.

B. One month tapering dose of Decadron starting at 4 mg qid, then 4 mg tid, etc if lesion is symptomatic.

C. Avastin 5-10 mg/Kg x 3 doses q 2 weeks (Khan et al., PMID 33593308).

D. Resection if refractory to dexamethasone and/or Avastin.

E. HBOT if les...