How do you manage symptomatic radiation necrosis not responsive to steroids?  

I agree with the above recommendations. We review these cases at our brain tumor board. We often start off with confirming the diagnosis using MRI with perfusion. If perfusion is equivocal (hard to interpret or lesion is too small) and the patient is asymptomatic, we follow. If the patient is sympto...

These cases are discussed at tumor board. Surgical resection is considered, when feasible. When it is not, we typically try bevacizumab next, and generally see good results. 

Differentiation between radiation necrosis and tumor progression can be difficult, but should be done prior to intervention if possible. Often the two entities are superimposed, escalating the diagnostic challenge.Evolving MRI techniques like perfusion and FTB mapping can be very useful in discrimin...

Adding celebrex is another surprisingly effective conservative measure. But if it's refractory, crani, bev or LITT.