Treatment of steroid refractory, Gamma Knife related radiation necrosis with bevacizumab: Case report and review of the literature

Abstract

Radiation necrosis is the most significant complication associted with Gamma Knife radiosurgery. It typically becomes manifest s a necrotic white matter lesion 3 or more months following treatent [3]. Treatment volume and radiation dose are the two most mportant predictors of radiation necrosis. Once radiation necrois has become clinically apparent treatment has historically been imited to corticosteroids. Antiplatelet agents, anticoagulants and yperbaric oxygen have been studied but there is currently minimal igh quality evidence to support their use in routine clinical pracice [6]. If the radiation necrosis fails to respond to steroid treatment herapeutic options are limited. Recent trials have highlighted a potential role for bevacizumab, a onoclonal antibody directed against vascular endothelial growth actor (VEGF) in the treatment of radiation necrosis from convenional radiation therapy [14]. We present a case of symptomatic adiation necrosis following Gamma Knife radiosurgery for muliple atypical WHO grade II meningiomas initially unresponsive o steroid treatment and ultimately responsive to bevacizumab herapy.