Pinaki Dutta1, Sivashanmugam Dhandapani2, Narendra Kumar3, Prakamya Gupta4, Chirag Ahuja5, Kanchan Kumar Mukherjee4. 1. Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. 2. Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India. Electronic address: ssdhandapani.neurosurg@gmail.com. 3. Department of Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India. 4. Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India. 5. Department of Radiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Abstract
BACKGROUND: Angiogenesis and vascular endothelial growth factor (VEGF) have recently been implicated in animal and clinical models of radiation-induced optic nerve, retinal, and brain necrosis. Although there are isolated case reports of anti-VEGF therapy with bevacizumab for management of radiation-induced brain necrosis, there are little data defining its role in radiation-induced optic nerve damage. PATIENTS AND METHODS: This study included patients with a sellar-suprasellar tumor who underwent intensity-modulated or Gamma Knife radiotherapy and developed radiation-induced optic neuritis (RION) refractory to 3 weeks of glucocorticoid therapy who received bevacizumab 5 mg/kg intravenously as initial dose, followed by subsequent doses of 10 mg/kg. RESULTS: Here we report 3 patients with sellar-suprasellar lesions undergoing conventional radiation therapy (2 cases) or Gamma Knife surgery (1 case) who had benefitted from anti-VEGF therapy following radiation-induced optic nerve damage. CONCLUSIONS: Early bevacizumab therapy in steroid-refractory RION shows gratifying results.
BACKGROUND: Angiogenesis and vascular endothelial growth factor (VEGF) have recently been implicated in animal and clinical models of radiation-induced optic nerve, retinal, and brain necrosis. Although there are isolated case reports of anti-VEGF therapy with bevacizumab for management of radiation-induced brain necrosis, there are little data defining its role in radiation-induced optic nerve damage. PATIENTS AND METHODS: This study included patients with a sellar-suprasellar tumor who underwent intensity-modulated or Gamma Knife radiotherapy and developed radiation-induced optic neuritis (RION) refractory to 3 weeks of glucocorticoid therapy who received bevacizumab 5 mg/kg intravenously as initial dose, followed by subsequent doses of 10 mg/kg. RESULTS: Here we report 3 patients with sellar-suprasellar lesions undergoing conventional radiation therapy (2 cases) or Gamma Knife surgery (1 case) who had benefitted from anti-VEGF therapy following radiation-induced optic nerve damage. CONCLUSIONS: Early bevacizumab therapy in steroid-refractory RION shows gratifying results.