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Abstract
BackgroundBevacizumab has been suggested as a new treatment modality for cerebral radiation necrosis due to its ability to block the effects of vascular endothelial growth factor (VEGF) in leakage-prone capillaries, though its use still remains controversial in clinical practice.MethodsThe use of bevacizumab in 17 patients with symptomatic cerebral radiation necrosis poorly controlled with dexamethasone steroid treatments was examined between March 2010 and January 2012. Bevacizumab therapy was administered for a minimum of two cycles (7.5 mg/kg, at two-week interval) with a median of four bevacizumab injections. Changes in bi-dimensional measurements of the largest radiation necrosis lesions were observed by gadolinium-enhanced and T2-weighted magnetic resonance imaging (MRI). Additionally, dexamethasone dosage, Karnofsky performance status (KPS), adverse event occurrence and associated clinical outcomes were recorded for each patient.ResultsMRI analysis revealed that the average reduction was 54.9% and 48.4% in post-gadolinium and T2-weighted sequence analysis, respectively. Significant clinical neurological improvements were expressed in 10 patients according to KPS values. Dexamethasone reduction was achieved four weeks after initiation of bevacizumab in all patients, with four patients successfully discontinuing dexamethasone treatment. Mild to moderate bevacizumab-related adverse events, such as fatigue, proteinuria and hypertension were observed in three patients. Upon follow-up at 4 to 12 months, 10 patients showed clinical improvement, and 7 patient deaths occurred from tumor progression (5 patients), recurrent necrosis (1 patient), and uncontrolled necrosis-induced edema (1 patient).ConclusionsThese findings suggest bevacizumab as a promising treatment for cerebral radiation necrosis induced by common radiation therapies, including external beam radiotherapy (EBRT), stereotactic radiosurgery (SRS), and fractionated stereotactic radiotherapy (FSRT).
Highlights
Bevacizumab has been suggested as a new treatment modality for cerebral radiation necrosis due to its ability to block the effects of vascular endothelial growth factor (VEGF) in leakage-prone capillaries, though its use still remains controversial in clinical practice
There remains controversy pertaining to the efficacy of this treatment, with some researchers claiming that bevacizumab treatment reverses cerebral radiation necrosis effectively [6], while others claim that such treatment increases the risk for over-pruning of blood vessels that could potentially exacerbate cerebral radiation necrosis [7]
magnetic resonance imaging (MRI) imaging revealed a primary response assessment showing an average reduction of 54.9% and 48.4% in post-gadolinium and T2-weighted scans, respectively
Summary
Bevacizumab has been suggested as a new treatment modality for cerebral radiation necrosis due to its ability to block the effects of vascular endothelial growth factor (VEGF) in leakage-prone capillaries, though its use still remains controversial in clinical practice. A randomized controlled clinical trial further demonstrated class I evidence of the efficacy of bevacizumab treatment for progressive radiation necrosis [5]. Despite these positive results, there remains controversy pertaining to the efficacy of this treatment, with some researchers claiming that bevacizumab treatment reverses cerebral radiation necrosis effectively [6], while others claim that such treatment increases the risk for over-pruning of blood vessels that could potentially exacerbate cerebral radiation necrosis [7]
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