{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T19:24:09Z","timestamp":1792265049430,"version":"4.4.0"},"reference-count":50,"publisher":"Springer Science and Business Media LLC","issue":"11","license":[{"start":{"date-parts":[[2022,8,29]],"date-time":"2022-08-29T00:00:00Z","timestamp":1661731200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,8,29]],"date-time":"2022-08-29T00:00:00Z","timestamp":1661731200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Klinikum rechts der Isar der Technischen Universit\u00e4t M\u00fcnchen"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Strahlenther Onkol"],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>The Working Group for Neurooncology of the German Society for Radiation Oncology (DEGRO; AG NRO) in cooperation with members of the Neurooncological Working Group of the German Cancer Society (DKG-NOA) aimed to define a\u00a0practical guideline for the diagnosis and treatment of radiation-induced necrosis (RN) of the central nervous system (CNS).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Panel members of the DEGRO working group invited experts, participated in a\u00a0series of conferences, supplemented their clinical experience, performed a\u00a0literature review, and formulated recommendations for medical treatment of RN, including bevacizumab, in clinical routine.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Diagnosis and treatment of RN requires multidisciplinary structures of care and defined processes. Diagnosis has to be made on an interdisciplinary level with the joint knowledge of a\u00a0neuroradiologist, radiation oncologist, neurosurgeon, neuropathologist, and neurooncologist. If the diagnosis of blood\u2013brain barrier disruptions (BBD) or RN is likely, treatment should be initiated depending on the symptoms, location, and dynamic of the lesion. Multiple treatment options are available (such as observation, surgery, steroids, and bevacizumab) and the optimal approach should be discussed in an interdisciplinary setting. In this practice guideline, we offer detailed treatment strategies for various scenarios.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00066-022-01973-8","type":"journal-article","created":{"date-parts":[[2022,8,29]],"date-time":"2022-08-29T20:03:56Z","timestamp":1661803436000},"page":"971-980","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":43,"title":["DEGRO practical guideline for central nervous system radiation necrosis part\u00a02: treatment"],"prefix":"10.1007","volume":"198","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5231-9097","authenticated-orcid":false,"given":"Denise","family":"Bernhardt","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laila","family":"K\u00f6nig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anca-L.","family":"Grosu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Rieken","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandro M.","family":"Krieg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfgang","family":"Wick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedikt","family":"Wiestler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Friederike","family":"Schmidt-Graf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Sahm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Gempt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Meyer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernd J.","family":"Krause","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cordula","family":"Petersen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rainer","family":"Fietkau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Thomas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Giordano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Wittig-Sauerwein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fcrgen","family":"Debus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghazaleh","family":"Tabatabai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Hau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joachim","family":"Steinbach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie E.","family":"Combs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Expert Panel of the German Society of Radiation Oncology (DEGRO)","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,8,29]]},"reference":[{"key":"1973_CR1","doi-asserted-by":"publisher","first-page":"2865","DOI":"10.1200\/JCO.2004.12.149","volume":"22","author":"JS Barnholtz-Sloan","year":"2004","unstructured":"Barnholtz-Sloan\u00a0JS et al (2004) Incidence proportions of brain metastases in patients diagnosed (1973 to 2001) in the Metropolitan Detroit Cancer Surveillance System. 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Lancet Oncol 18:e143","journal-title":"Lancet Oncol"}],"container-title":["Strahlentherapie und Onkologie"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00066-022-01973-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00066-022-01973-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00066-022-01973-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,19]],"date-time":"2022-10-19T10:03:19Z","timestamp":1666173799000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00066-022-01973-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,29]]},"references-count":50,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2022,11]]}},"alternative-id":["1973"],"URL":"https:\/\/doi.org\/10.1007\/s00066-022-01973-8","relation":{},"ISSN":["0179-7158","1439-099X"],"issn-type":[{"value":"0179-7158","type":"print"},{"value":"1439-099X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,29]]},"assertion":[{"value":"11 June 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 June 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 August 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"D.\u00a0Bernhardt reports personal fees and honoraria from Accuray Inc., AstraZeneca, and Novocure GmbH outside the submitted work. DB\u2019s spouse is employed at Gilead Science. L.\u00a0K\u00f6nig reports grants from Ruprecht-Karls Universit\u00e4t Heidelberg, and personal fees from Accuray Inc. and Novocure GmbH outside the submitted work. J.\u00a0Debus: institution received research grants from Merck Serono, institution received consultation honoraria from Merck serono, JD received travel reimbursement from Merck Serono, institution received research grants from Siemens Healthineers and Accuray. S.\u00a0Rieken is consultant for Brainlab AG (Munich, Germany) and Ulrich Medical (Ulm, Germany). S.K. received honoraria from Nexstim Plc (Helsinki, Finland), Spineart Deutschland GmbH (Frankfurt, Germany), Medtronic (Meerbusch, Germany), and Carl Zeiss Meditec (Oberkochen, Germany). M.\u00a0Thomas reports personal fees, honoraria for advisory boards, and research funding from AstraZeneca, Beigene, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Chugai, Daiichi Sankyo, GlaxoSmithKline, Janssen Oncology, Lilly, Merck, MSD, Novartis, Pfizer, Roche, Sanofi, and Takeda. F.\u00a0Giordano reports research grants, honoraria, and travel expenses from Carl Zeiss Meditec AG and NOXXON Pharma AG, personal fees from MVZ Venusberg GmbH, and consulting\/speaker honoraria from Bristol Myers Squibb, Medac GmbH, Merck Sharp & Dohme, Elsevier, AstraZeneca, and Guerbet SA. A.-L.\u00a0Grosu, S.M.\u00a0Krieg, W.\u00a0Wick, B.\u00a0Wiestler, F.\u00a0Schmidt-Graf, F.\u00a0Sahm, J.\u00a0Gempt, B.\u00a0Meyer, B.J.\u00a0Krause, C.\u00a0Petersen, R.\u00a0Fietkau, A.\u00a0Wittig-Sauerwein, G.\u00a0Tabatabai, P.\u00a0Hau, J.\u00a0Steinbach, S.E.\u00a0Combs, and the Expert Panel of the German Society of Radiation Oncology (DEGRO) declare that they have no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Ethics approval was not necessary for the comprehensive review article. All co-authors have agreed to participate<b><i>. <\/i><\/b><i>Consent for publication<\/i>: All co-authors have approved the final manuscript.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical standards"}}]}}