Timothy K Nguyen1, James Perry2, Arun N E Sundaram3, Jay Detsky1, Pejman J Maralani4, Eirena Calabrese2, Sunit Das5, Arjun Sahgal6. 1. Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, T-Wing 2nd Floor, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada. 2. Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. 3. Division of Neuro-Ophthalmology, Department of Ophthalmology & Vision Services, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. 4. Division of Neuroradiology, Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. 5. Division of Neurosurgery, St. Michael'S Hospital, University of Toronto, Toronto, ON, Canada. 6. Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, T-Wing 2nd Floor, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada. arjun.sahgal@sunnybrook.ca.
Abstract
PURPOSE: Radiation-induced pseudoprogression is a subacute clinical entity that is distinct from radiation necrosis and mimics tumor progression. Bevacizumab is a well-described treatment option for radiation necrosis, but its role in pseudoprogression is not clearly defined. METHODS: We report a case of radiation-induced pseudoprogression rescued with bevacizumab in a 20-year-old man with a biopsy-proven low-grade astrocytoma of the tectum. A review of the literature was also conducted specific to bevacizumab as a treatment for symptomatic pseudoprogression after radiotherapy for CNS tumors. RESULTS: This patient was treated with definitive intensity modulated stereotactic radiotherapy at a total dose of 54 Gy delivered in 30 daily fractions. Six weeks after radiotherapy the patient developed progressive headache, weakness and a documented deterioration in vision, which was accompanied by worsening of radiographic findings. A diagnosis of pseudoprogression was made and after limited benefit from a trial of dexamethasone, four cycles of bevacizumab were administered which resulted in rapid clinical and radiographic improvement. CONCLUSIONS: Our findings support the potential use of bevacizumab as a rescue agent for symptomatic pseudoprogression.
PURPOSE: Radiation-induced pseudoprogression is a subacute clinical entity that is distinct from radiation necrosis and mimics tumor progression. Bevacizumab is a well-described treatment option for radiation necrosis, but its role in pseudoprogression is not clearly defined. METHODS: We report a case of radiation-induced pseudoprogression rescued with bevacizumab in a 20-year-old man with a biopsy-proven low-grade astrocytoma of the tectum. A review of the literature was also conducted specific to bevacizumab as a treatment for symptomatic pseudoprogression after radiotherapy for CNS tumors. RESULTS: This patient was treated with definitive intensity modulated stereotactic radiotherapy at a total dose of 54 Gy delivered in 30 daily fractions. Six weeks after radiotherapy the patient developed progressive headache, weakness and a documented deterioration in vision, which was accompanied by worsening of radiographic findings. A diagnosis of pseudoprogression was made and after limited benefit from a trial of dexamethasone, four cycles of bevacizumab were administered which resulted in rapid clinical and radiographic improvement. CONCLUSIONS: Our findings support the potential use of bevacizumab as a rescue agent for symptomatic pseudoprogression.
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