Long-Term Relief of Cerebral Radiation Necrosis Treated with Low-Dose Bevacizumab - a Report of 2 Cases

Hu, Qiong; Zhao, Juan; Xu, Jing; Zhou, Xiaofeng; Shui, Yongjie; Shen, Long; Wei, Qichun

doi:10.1159/000455868

Cited by 3 publications

(1 citation statement)

References 15 publications

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“…Neuro-Oncology Practice oxygen, and antiplatelet and anticoagulation medications have been offered with varying degrees of success. 5,[10][11][12] In cases of treatment-refractory or "malignant radiation necrosis, " more invasive treatment options such as laser interstitial thermal therapy or surgical resection may be required. However, the current literature surrounding the safety and efficacy of surgical resection is limited to smaller case series and case studies, and direct comparison is difficult because of a lack of consistency in histopathology and reporting outcomes.…”

Section: Shah Et Al Craniotomy For Refractory Radiation Necrosismentioning

confidence: 99%

Salvage craniotomy for treatment-refractory symptomatic cerebral radiation necrosis

Shah

Mahavadi

Morell

et al. 2019

Neuro-Oncology Practice

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Background The incidence of symptomatic radiation necrosis (RN) has risen as radiotherapy is increasingly used to control brain tumor progression. Traditionally managed with steroids, symptomatic RN can remain refractory to medical treatment, requiring surgical intervention for control. The purpose of our study was to assess a single institution’s experience with craniotomy for steroid-refractory pure RN. Methods The medical records of all tumor patients who underwent craniotomies at our institution from 2011 to 2016 were retrospectively reviewed for a history of preoperative radiotherapy or radiosurgery. RN was confirmed histopathologically and patients with active tumor were excluded. Preoperative, intraoperative, and outcome information was collected. Primary outcomes measured were postoperative KPS and time to steroid freedom. Results Twenty-four patients with symptomatic RN were identified. Gross total resection was achieved for all patients. Patients with metastases experienced an increase in KPS (80 vs 100, P < .001) and required a shortened course of dexamethasone vs patients with high-grade gliomas (3.4 vs 22.2 weeks, P = .003). RN control and neurological improvement at 13.3 months’ follow-up were 100% and 66.7%, respectively. Adrenal insufficiency after rapidly tapering dexamethasone was the only morbidity (n = 1). Overall survival was 93.3% (14/15) at 1 year. Conclusion In cases of treatment-refractory symptomatic RN, resection can lead to an overall improvement in postoperative health status and neurological outcomes with minimal RN recurrence. Craniotomy for surgically accessible RN can safely manage symptomatic patients, and future studies assessing the efficacy of resection vs bevacizumab may be warranted.

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Section: Shah Et Al Craniotomy For Refractory Radiation Necrosismentioning

confidence: 99%

Salvage craniotomy for treatment-refractory symptomatic cerebral radiation necrosis

Shah

Mahavadi

Morell

et al. 2019

Neuro-Oncology Practice

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Bevacizumab

2017

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Bevacizumab for pediatric radiation necrosis

Baroni

Alderete

Solano-Páez

et al. 2020

Neuro-Oncology Practice

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Background Radiation necrosis is a frequent complication occurring after the treatment of pediatric brain tumors; however, treatment options remain a challenge. Bevacizumab is an anti-VEGF monoclonal antibody that has been shown in small adult cohorts to confer a benefit, specifically a reduction in steroid usage, but its use in children has not been well described. Methods We describe our experience with bevacizumab use for symptomatic radiation necrosis at 5 institutions including patients treated after both initial irradiation and reirradiation. Results We identified 26 patients treated with bevacizumab for symptomatic radiation necrosis, with a wide range of underlying diagnoses. The average age at diagnosis of radiation necrosis was 10.7 years, with a median time between the last dose of radiation and the presentation of radiation necrosis of 3.8 months (range, 0.6-110 months). Overall, we observed that 13 of 26 patients (50%) had an objective clinical improvement, with only 1 patient suffering from significant hypertension. Radiological improvement, defined as reduced T2/fluid-attenuated inversion recovery signal and mass effect, was observed in 50% of patients; however, this did not completely overlap with clinical response. Both early and late radiation necrosis responded equally well to bevacizumab therapy. Overall, bevacizumab was very well tolerated, permitting a reduction of corticosteroid dose and/or duration in the majority of patients. Conclusions Bevacizumab appears to be effective and well-tolerated in children as treatment for symptomatic radiation necrosis and warrants more robust study in the context of controlled clinical trials.

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Long-Term Relief of Cerebral Radiation Necrosis Treated with Low-Dose Bevacizumab - a Report of 2 Cases

Cited by 3 publications

References 15 publications

Salvage craniotomy for treatment-refractory symptomatic cerebral radiation necrosis

Salvage craniotomy for treatment-refractory symptomatic cerebral radiation necrosis

Bevacizumab

Bevacizumab for pediatric radiation necrosis

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