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Review of cranial radiotherapy-induced vasculopathy

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Abstract

Cranial radiation can impact the cerebral vasculature in many ways, with a wide range of clinical manifestations. The incidence of these late effects including cerebrovascular accidents (CVAs), lacunar lesions, vascular occlusive disease including moyamoya syndrome, vascular malformations, and hemorrhage is not well known. This article reviews the preclinical findings regarding the pathophysiology of late radiation-induced vascular damage, and discusses the clinical incidence and risk factors for each type of vasculopathy. The pathophysiology is complex and dependent on the targeted blood vessels, and upregulation of pro-inflammatory and hypoxia-related genes. The risk factors for adult CVAs are similar to those for patients not exposed to cranial radiotherapy. For children, risks for late vascular complications include young age at radiotherapy, radiotherapy dose, NF1, tumor location, chemotherapy, and endocrine abnormalities. The incidence of late vascular complications of radiotherapy may be impacted by improved technology, therapeutic interventions, and appropriate follow up.

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Conflict of interest

Dr. Chao is a Member of Varian’s Speaker Bureau. Dr. Suh is a Consultant for Varian. Otherwise no additional authors had Conflicts of interest/Disclosures. There was no funding to support this research.

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Authors and Affiliations

  1. Department of Radiation Oncology, Cleveland Clinic, 9500 Euclid Ave., T28, Cleveland, OH, 44195, USA

    Erin S. Murphy, Jennifer S. Yu, Samuel T. Chao & John H. Suh

  2. Cleveland Clinic Lerner College of Medicine, 9500 Euclid Ave., T28, Cleveland, OH, 44195, USA

    Hao Xie

  3. Division of Radiation Oncology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Mail Stop 220, Memphis, TN, 38105-3678, USA

    Thomas E. Merchant

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  1. Erin S. Murphy
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  2. Hao Xie
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  3. Thomas E. Merchant
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  4. Jennifer S. Yu
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  5. Samuel T. Chao
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  6. John H. Suh
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Correspondence to Erin S. Murphy.

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Murphy, E.S., Xie, H., Merchant, T.E. et al. Review of cranial radiotherapy-induced vasculopathy. J Neurooncol 122, 421–429 (2015). https://doi.org/10.1007/s11060-015-1732-2

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