Le bévacizumab dans le traitement des radionécroses cérébrales

Gronier, S.; Bourg, V.; Frénay, M.; Cohen, M.; Mondot, Lydiane; Thomas, P.; Lebrun, C.

doi:10.1016/j.neurol.2010.10.012

Cited by 10 publications

(4 citation statements)

References 4 publications

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“…Medical literature also reveals similar examples. In the study by Gronier et al, no clinical improvement was observed in all three participants with malignant brain tumors after BV therapy (10 mg/kg per month) [81]. One patient had experienced lymphopenia after one perfusion of bevacizumab; the other had developed a transient ischemic attack and a corneal ulcer.…”

Section: Discussionmentioning

confidence: 87%

Bevacizumab for radiation necrosis following radiotherapy of brain metastatic disease: a systematic review & meta-analysis

et al. 2021

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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, Medline, EMBASE, and Cochrane library were searched with various search keywords such as “bevacizumab” OR “anti-VEGF monoclonal antibody” AND “radiation necrosis” OR “radiation-induced brain necrosis” OR “RN” OR “RBN” AND “Brain metastases” OR “BM” until 1st Aug 2020. Studies reporting the efficacy and safety of BV treatment for BM patients with RN were retrieved. Study selection and data extraction were carried out by independent investigators. Open Meta Analyst software was used as a random effects model for meta-analysis to obtain mean reduction rates. Results Two prospective, seven retrospective, and three case report studies involving 89 patients with RN treated with BV were included in this systematic review and meta-analysis. In total, 83 (93%) patients had a recorded radiographic response to BV therapy, and six (6.7%) had experienced progressive disease. Seven studies (n = 73) reported mean volume reductions on gadolinium-enhanced T1 (mean: 47.03%, +/− 24.4) and T2-weighted fluid-attenuated inversion recovery (FLAIR) MRI images (mean: 61.9%, +/− 23.3). Pooling together the T1 and T2 MRI reduction rates by random effects model revealed a mean of 48.58 (95% CI: 38.32–58.85) for T1 reduction rate and 62.017 (95% CI: 52.235–71.799) for T2W imaging studies. Eighty-five patients presented with neurological symptoms. After BV treatment, nine (10%) had stable symptoms, 39 (48%) had improved, and 34 (40%) patients had complete resolution of their symptoms. Individual patient data was available for 54 patients. Dexamethasone discontinuation or reduction in dosage was observed in 30 (97%) of 31 patients who had recorded dosage before and after BV treatment. Side effects were mild. Conclusions Bevacizumab presents a promising treatment strategy for patients with RN and brain metastatic disease. Radiographic response and clinical improvement was observed without any serious adverse events. Further class I evidence would be required to establish a bevacizumab recommendation in this group of patients.

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Section: Discussionmentioning

confidence: 87%

Bevacizumab for radiation necrosis following radiotherapy of brain metastatic disease: a systematic review & meta-analysis

et al. 2021

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“…The medical literature reveals similar examples. In a study by Gronier et al, no clinical improvement was observed in any of three patients with malignant brain tumors after bevacizumab therapy (10 mg/kg per month) (62). One patient experienced lymphopenia after one perfusion of bevacizumab; the other developed a transient ischemic attack and a corneal ulcer (62).…”

Section: Discussionmentioning

confidence: 96%

Bevacizumab Treatment of Radiation-Induced Brain Necrosis: A Systematic Review

et al. 2021

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BackgroundRadiation brain necrosis (RBN) is a serious complication in patients receiving radiotherapy for intracranial disease. Many studies have investigated the efficacy and safety of bevacizumab in patients with RBN. In the present study, we systematically reviewed the medical literature for studies reporting the efficacy and safety of bevacizumab, as well as for studies comparing bevacizumab with corticosteroids.Materials and MethodsWe searched PubMed, Cochrane library, EMBASE, and ClinicalTrials.gov from their inception through 1 March, 2020 for studies that evaluated the efficacy and safety of bevacizumab in patients with RBN. Two investigators independently performed the study selection, data extraction, and data synthesis.ResultsOverall, the present systematic review included 12 studies (eight retrospective, two prospective, and two randomized control trials [RCTs]) involving 236 patients with RBN treated who were treated with bevacizumab. The two RCTs also had control arms comprising patients with RBN who were treated with corticosteroids/placebo (n=57). Radiographic responses were recorded in 84.7% (200/236) of patients, and radiographic progression was observed in 15.3% (36/236). Clinical improvement was observed in 91% (n=127) of responding patients among seven studies (n=113). All 12 studies reported volume reduction on T1 gadolinium enhancement MRI (median: 50%, range: 26%–80%) and/or T2 FLAIR MRI images (median: 59%, range: 48%–74%). In total, 46 responding patients (34%) had recurrence. The two RCTs revealed significantly improved radiographic response in patients treated with bevacizumab (Levin et al.: p = 0.0013; Xu et al.: p < 0.001). Both also showed clinical improvement (Levin et al.: NA; Xu et al.: p = 0.039) and significant reduction in edema volume on both T1 gadolinium enhancement MRI (Levin et al.: p=0.0058; Xu et al.: p=0.027) and T2 FLAIR MRI (Levin et al.: p=0.0149; Xu et al.: p < 0.001). Neurocognitive improvement was significantly better after 2 months of treatment in patients receiving bevacizumab than in those given corticosteroids, as assessed by the MoCA scale (p = 0.028). The recurrence rate and side effects of the treatments showed no significant differences.ConclusionsPatients with RBN respond to bevacizumab, which can improve clinical outcomes and cognitive function. Bevacizumab appears to be more efficacious than corticosteroid-based treatment. The safety profile was comparable to that of the corticosteroids.

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“…Corticotherapy , hyperbaric oxygen has also been reported. Bevacizumab antibody neutralizing the effect of vascular endothelium growth factor (VEGF)) has been recently used as treatment of CRN resisting conventional drug treatmeny and hyperbaric oxygen (16) .…”

Section: Discussionmentioning

confidence: 99%

Brain Radionecrosis in Patients Irradiated for Nasopharngeal Carcinoma : About Four Cases

Lahlali

Echchikhi²,

Chbili³

et al. 2017

IAM

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Purpose: to study the clinical, radiological, therapeutic and progressive aspects of brain radionecrosis after treatment for nasopharyngel carcinoma. Patients and methods: four patients ( two men and two women) of mean age 53.5 years were treated for UCNT( undifferentiated carcinoma of the nasopharynx), between 2009and 2014, and developed cerebral radionecrosis. All patients were treated with radical radiotherapy. The mean dose was 70 Gy. Dose per fraction was 2 Gy, one fraction daily. All patients received chemotherapy. Result: patients presented non specific neurological signs, and one case was discovered fortuitously. The mean latent periode was 46 months, brain radionecrosis was authetificated by brain imaging. The localisation was temporal in two patients and bulbomedullar in two patients. After a mean follow-up period of 14 months, clinical outcomes were favorable in one case, stabilisation in two cases and one patient died. Conclusion: brain radionecrosis is a rare iatrogenic complication for patients irradiated for UCNT. Imaging techniques play a major role in the diagnosis. Corticotherapy is the main treatment.

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Le bévacizumab dans le traitement des radionécroses cérébrales

Cited by 10 publications

References 4 publications

Bevacizumab for radiation necrosis following radiotherapy of brain metastatic disease: a systematic review & meta-analysis

Bevacizumab for radiation necrosis following radiotherapy of brain metastatic disease: a systematic review & meta-analysis

Bevacizumab Treatment of Radiation-Induced Brain Necrosis: A Systematic Review

Brain Radionecrosis in Patients Irradiated for Nasopharngeal Carcinoma : About Four Cases

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