2021
DOI: 10.1186/s12885-021-07889-3
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Bevacizumab for radiation necrosis following radiotherapy of brain metastatic disease: a systematic review & meta-analysis

Abstract: Background Radiotherapy is the mainstay of brain metastasis (BM) management. Radiation necrosis (RN) is a serious complication of radiotherapy. Bevacizumab (BV), an anti-vascular endothelial growth factor monoclonal antibody, has been increasingly used for RN treatment. We systematically reviewed the medical literature for studies reporting the efficacy and safety of bevacizumab for treatment of RN in BM patients. Materials and methods PubMed, Medl… Show more

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Cited by 37 publications
(74 citation statements)
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References 79 publications
(403 reference statements)
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“…It is possible that anti-angiogenic therapy with bevacizumab may improve TKI delivery and efficacy in the CNS through modulation of the tumor vasculature. 41 Furthermore, of note, bevacizumab has additionally demonstrated efficacy in treating brain radiation necrosis, 42 , 43 which is not uncommon in ALK -rearranged NSCLC given the frequency of CNS metastases which may require local therapies.…”
Section: Discussionmentioning
confidence: 99%
“…It is possible that anti-angiogenic therapy with bevacizumab may improve TKI delivery and efficacy in the CNS through modulation of the tumor vasculature. 41 Furthermore, of note, bevacizumab has additionally demonstrated efficacy in treating brain radiation necrosis, 42 , 43 which is not uncommon in ALK -rearranged NSCLC given the frequency of CNS metastases which may require local therapies.…”
Section: Discussionmentioning
confidence: 99%
“…Bevacizumab, an anti-vascular endothelial growth factor (VEGF) monoclonal antibody that inhibits the pro-inflammatory response, is increasingly used. Bevacizumab may elicit a dramatic response and significant MRI findings with rapid volume reduction on both contrast enhanced T1-weighted and T2-weighted MR images and reported mean reduction rates in follow-up of 62.017 and 48.58% respectively [ 30 ]. According to a recent meta-analysis, bevacizumab can be considered safe and efficacious for the treatment of radiation necrosis in brain metastases, however, the level of evidence was low [ 30 ].…”
Section: Discussionmentioning
confidence: 99%
“…A relief effect of bevacizumab on edema induced by radiotherapy, mainly in malignant tumors, has been described. [ 12 , 25 , 31 , 32 ] However, there is still no hard evidence of an impact on overall survival and toxicity-related data remain limited. Italian Authorities approved the use of bevacizumab in the context of recurrent cerebral neoplasms and radiation-induced peritumoral edema since January 2021; therefore, it was not routinely used in our institution.…”
Section: Discussionmentioning
confidence: 99%
“…Bevacizumab, though not commonly used in clinical practice to treat peritumoral edema, might be considered in case of PTBE with or without concurrent malignant tumor progression as well as in case of radiation-induced PTBE. [ 12 , 25 , 31 , 32 ] However, its use is often precluded by national and institutional guidelines as well as the degree of urgency for neurosurgical intervention. We present a small series of three patients with skull-base tumors who developed PTBE induced by stereotactic radiosurgery (SRS) and eventually underwent surgery.…”
Section: Introductionmentioning
confidence: 99%