Durable response of intracranial cellular hemangioma to bevacizumab and temozolomide

Abstract

<jats:p>Cellular hemangioma is a subtype of hemangioma that is associated with cellular immaturity and the potential for recurrence. Intracranial location of these lesions is extremely rare, and definitive treatment often requires radical neurosurgical resection. The authors report a case of a 12-year-old boy with a subtemporal cellular hemangioma. He underwent gross-total resection of the tumor, but within 1.5 months the tumor recurred, necessitating a second resection. Because of its proximity to vascular structures, only subtotal resection was possible. Repeat MRI 1 month after the second surgery showed significant tumor recurrence. Given the tumor's demonstrated capacity for recurrence and its proximity to the vein of Labbé and sigmoid sinus, further resection was not indicated. In an effort to limit radiation therapy for this young patient, treatment with bevacizumab and temozolomide was chosen and achieved a complete response that has proven durable for 36 months after cessation of therapy. This is the first report of the successful use of chemotherapy to treat an intracranial hemangioma, a rare condition with limited therapeutic options.</jats:p>

A case of giant fetal intracranial capillary hemangioma cured with propranolol

“…In particular, the various therapies for these tumors include surgical removal, systemic steroid therapy, thalidomide, intralesional triamcinolone, bevacizumab, temozolomide, interferon, and clinical observation. 2,3,[6][7][8][9][21][22][23]25 The same variations in treatment were observed for capillary hemangiomas in the skin until 2008, when Léauté-Labrèze et al…”

“…In particular, the various therapies for these tumors include surgical removal, systemic steroid therapy, thalidomide, intralesional triamcinolone, bevacizumab, temozolomide, interferon, and clinical observation. 2,3,[6][7][8][9][21][22][23]25 The same variations in treatment were observed for capillary hemangiomas in the skin until 2008, when Léauté-Labrèze et al10 described 11 patients with complicated infantile hemangiomas who were treated with propranolol and exhibited dramatic lesion regression within a short time period with minimal adverse effects. Subsequently, many authors began to examine propranolol and its role in capillary hemangioma treatment and have suggested this beta-blocker as a first-line treatment for severe infantile capillary hemangiomas.…”

“…Surgery was performed in certain cases, whereas other cases involved clinical observation and/or treatment with steroids, thalidomide, bevacizumab, and/or temozolomide. 3,4,13,25 A different scenario is applicable for cutaneous hemangiomas. 12,15,24 In particular, for such tumors, propranolol has been the first-line treatment since Léauté-Labrèze et al 10 published a case series in 2008 that described severe infantile hemangiomas treated with this beta-blocker with excellent outcomes.…”

Intralesional Bevacizumab for the Treatment of Recurrent Sinonasal Hemangioma

“…This involution was sustained at 36 months after cessation of therapy. 14 Ophthalmologic data also contain multiple reports of intravitreal bevacizumab therapy for retinal hemangiomas, with overall favorable outcomes. 15-18 Steeples et al 3 described the use of intralesional bevacizumab for a cutaneous capillary hemangioma of the eyelid, associated with pregnancy.…”

Surgical management of intracranial capillary hemangiomas in children: report of 2 cases

“…5 Similarly using another antiangiogenic agent, bevacizumab, along with temozolomide, an intracranial cellular hemangioma in an infant was successfully treated. 18 Cellular hemangioma is considered a more aggressive lesion but is related to ICH along the spectrum of vasoproliferative lesions.…”