PURPOSE: Because blocking vascular endothelial growth factor (VEGF) from reaching leaky capillaries is a logical strategy for the treatment of radiation necrosis, we reasoned that bevacizumab might be an effective treatment of radiation necrosis. PATIENTS AND METHODS: Fifteen patients with malignant brain tumors were treated with bevacizumab or bevacizumab combination for their tumor on either a 5 mg/kg/2-week or 7.5 mg/kg/3-week schedule. Radiation necrosis was diagnosed in 8 of these patients on the basis of magnetic resonance imaging (MRI) and biopsy. MRI studies were obtained before treatment and at 6-week to 8-week intervals. RESULTS: Of the 8 patients with radiation necrosis, posttreatment MRI performed an average of 8.1 weeks after the start of bevacizumab therapy showed a reduction in all 8 patients in both the MRI fluid-attenuated inversion-recovery (FLAIR) abnormalities and T1-weighted post-Gd-contrast abnormalities. The average area change in the T1-weighted post-Gd-contrast abnormalities was 48% (+/-22 SD), and the average change in the FLAIR images was 60% (+/-18 SD). The average reduction in daily dexamethasone requirements was 8.6 mg (+/-3.6). CONCLUSION: Bevacizumab, alone and in combination with other agents, can reduce radiation necrosis by decreasing capillary leakage and the associated brain edema. Our findings will need to be confirmed in a randomized trial to determine the optimal duration of treatment.
PURPOSE: Because blocking vascular endothelial growth factor (VEGF) from reaching leaky capillaries is a logical strategy for the treatment of radiation necrosis, we reasoned that bevacizumab might be an effective treatment of radiation necrosis. PATIENTS AND METHODS: Fifteen patients with malignant brain tumors were treated with bevacizumab or bevacizumab combination for their tumor on either a 5 mg/kg/2-week or 7.5 mg/kg/3-week schedule. Radiation necrosis was diagnosed in 8 of these patients on the basis of magnetic resonance imaging (MRI) and biopsy. MRI studies were obtained before treatment and at 6-week to 8-week intervals. RESULTS: Of the 8 patients with radiation necrosis, posttreatment MRI performed an average of 8.1 weeks after the start of bevacizumab therapy showed a reduction in all 8 patients in both the MRI fluid-attenuated inversion-recovery (FLAIR) abnormalities and T1-weighted post-Gd-contrast abnormalities. The average area change in the T1-weighted post-Gd-contrast abnormalities was 48% (+/-22 SD), and the average change in the FLAIR images was 60% (+/-18 SD). The average reduction in daily dexamethasone requirements was 8.6 mg (+/-3.6). CONCLUSION:Bevacizumab, alone and in combination with other agents, can reduce radiation necrosis by decreasing capillary leakage and the associated brain edema. Our findings will need to be confirmed in a randomized trial to determine the optimal duration of treatment.
Authors: Joost J C Verhoeff; Olaf van Tellingen; An Claes; Lukas J A Stalpers; Myra E van Linde; Dirk J Richel; William P J Leenders; Wouter R van Furth Journal: BMC Cancer Date: 2009-12-16 Impact factor: 4.430
Authors: Haroon Ahmad; David Martin; Sohil H Patel; Joseph Donahue; Beatriz Lopes; Benjamin Purow; David Schiff; Camilo E Fadul Journal: J Neurooncol Date: 2019-09-23 Impact factor: 4.130