Relief Effect of Bevacizumab on Severe Edema Induced by Re-irradiation in Brain Tumor Patients

Ge, Shuping; Wang, Yingjie; Guan, Yao; Dong, Dapeng; Yang, Gang; Li, Dan; Hao, Ruimin; Sun, Hongguang; Zhou, Ming; Wang, Kunpeng; Zhou, Shixiang; Wang, Qinwen; Wu, Shikai; Zeng, Yanjun

doi:10.4103/0366-6999.161403

Cited by 9 publications

(7 citation statements)

References 11 publications

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“…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%

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The positive effects of surgery on symptomatic stereotactic radiation-induced peritumoral brain edema: A report of three cases

Stefini

Peron

Lacamera

et al. 2021

Surgical Neurology International

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Background: Peritumoral brain edema is an uncommon but life-threatening side effect of brain tumors radiosurgery. Medical therapy usually alleviates symptoms until edema spontaneously disappears. However, when peritumoral brain edema endangers the patient’s life or medical therapy fails to guarantee an acceptable quality of life, surgery might be considered. Case Description: Our report focuses on three patients who developed extensive peritumoral brain edema after radiosurgery. Two were affected by vestibular schwannomas and one by a skull-base meningioma. Peritumoral brain edema worsened despite maximal medical therapy in all cases; therefore, surgical removal of the radiated lesion was carried out. In the first patient, surgery was overdue and resulted in a fatal outcome. On the other hand, in the latter two cases surgery was quickly effective. In all three cases, an unmanageable brain swelling was not found at surgery. Conclusion: Surgical removal of brain tumors previously treated with radiosurgery was safe and effective in resolving shortly peritumoral brain edema. This solution should be considered in patients who do not respond to medical therapy and before worsening of clinical conditions. Interestingly, the expected brain swelling was not confirmed intraoperatively. In our experience, this magnetic resonance finding should not be considered a criterion to delay surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The positive effects of surgery on symptomatic stereotactic radiation-induced peritumoral brain edema: A report of three cases

Stefini

Peron

Lacamera

et al. 2021

Surgical Neurology International

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“…Recently, our case series study of 10 patients showed that bevacizumab therapy effectively relieved serious brain edema associated with reirradiation in patients. [ 13 ] It was demonstrated that bevacizumab therapy benefited nonsmall-cell lung cancer patients with brain metastases symptomatically by consistently decreasing PTBE. [ 14 ] Our present study included 59 patients and showed bevacizumab therapy was effective with a response rate reaching 84.74%.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of bevacizumab treatment for refractory brain edema

Meng

Zhao²,

Ge³

et al. 2017

Medicine

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Objective:This retrospective study investigated the efficacy and safety of bevacizumab treatment for refractory brain edema.Methods:Between March 2009 and December 2015, bevacizumab was used to treat 59 cases of brain metastatic patients with refractory brain edema. The median dose of bevacizumab was 4.68 mg/kg (range 2.8–6.52 mg/kg). The clinical-pathological data, the efficacy, and the side effects of bevacizumab were recorded. Magnetic resonance imaging (MRI) was performed before and after bevacizumab treatment. Tumor and edema volumes were measured separately.Results:The clinical symptoms of 50 out of 59 cases (84.74%) improved the day after the bevacizumab treatment, and the edema volumes of 55 (93.22%) cases were reduced after the bevacizumab treatment. The average edema volume was significantly reduced after bevacizumab treatment from 125,583.43 ± 14,093.27 to 71,613.42 ± 9473.42 mm3 (Mann–Whitney rank test, P < .01), and the average edema index was significantly reduced from 25.66 ± 11.54 to 17.87 ± 6.87 (Mann–Whitney rank test, P < .01). One patient died from a hemorrhage due to a cancerous-ulcer of the maxillary sinus. The main complication observed was hypertension, which was observed in 11 cases (18.6%).Conclusion:The effective rate of bevacizumab for refractory brain edema is 84.74%. Hypertension was the main side effect of the bevacizumab treatment. Bevacizumab is an effective and relatively safe treatment for brain edema.

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“…[12][13][14][15] Many studies have shown that administration of bevacizumab at a dosage (5 mg/kg every 2-4 weeks) lower than that used for oncological protocols is effective for radiation brain necrosis. 2,4,16,17 However, the most appropriate dosage remains to be found. Third, a recent study cautiously showed that repeated bevacizumab treatment may induce drug-resistance following the progression of radiation brain necrosis.…”

Section: Discussionmentioning

confidence: 99%

“…17 This effect lasted for The woman was diagnosed with radiation brain necrosis for 1 year. Gadolinium-enhanced T1-weighted MRI in February 2015 showed widespread scattered irregular enhancement (A) and T2-weighted FLAIR MRI showed a large edema in the surrounding tissue (G).…”

Section: Discussionmentioning

confidence: 99%

Efficacy of repeated low-dose bevacizumab treatment with long-dosing interval for radiation-induced brain necrosis: A case report

Meng

Zhao

et al. 2017

Cancer Biology & Therapy

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A 40-year-old Chinese female patient, with radiation-induced brain necrosis after radiosurgery, was treated 6 times with a single dose of 200 mg (3.27 mg/kg) bevacizumab each time, and with an interval of 12-16 weeks between each treatment. Neurological symptoms such as dizziness, fatigue, and headache disappeared after each administration of bevacizumab. The results suggest that repeated bevacizumab treatment using a low-dose and long-dosing interval may significantly alleviate radiation necrosis and its symptoms.

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Relief Effect of Bevacizumab on Severe Edema Induced by Re-irradiation in Brain Tumor Patients

Cited by 9 publications

References 11 publications

The positive effects of surgery on symptomatic stereotactic radiation-induced peritumoral brain edema: A report of three cases

The positive effects of surgery on symptomatic stereotactic radiation-induced peritumoral brain edema: A report of three cases

Efficacy and safety of bevacizumab treatment for refractory brain edema

Efficacy of repeated low-dose bevacizumab treatment with long-dosing interval for radiation-induced brain necrosis: A case report

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