Skip to main content

Advertisement

SpringerLink
Log in

Initial experience with bevacizumab treatment for biopsy confirmed cerebral radiation necrosis

  • Clinical Study - Patient Study
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Background Cerebral radiation necrosis is a serious complication of radiation treatment for brain tumors. Therapeutic options include corticosteroids, anticoagulation and hyperbaric oxygen with limited efficacy. Bevacizumab, an antibody against VEGF had been reported to reduce edema in patients with suspected radiation necrosis. We retrospectively reviewed 6 patients with biopsy proven cerebral radiation necrosis treated with bevacizumab between 2006 and 2008. Results Interval MRI follow-up demonstrated radiographic response in all patients with an average reduction of 79% for the post gadolinium studies and 49% for the FLAIR images. The initial partial radiographic response was noted for up to a mean follow-up time of 5.9 months (6 weeks to 18 months). Conclusion Bevacizumab appears to produce radiographic response and clinical benefits in the treatment of patients with cerebral radionecrosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Giglio P, Gilbert MR (2003) Cerebral radiation necrosis. Neurology 9(4):180–188. doi:10.1097/01.nrl.0000080951.78533.c4

    Article  Google Scholar 

  2. Cross N, Glantz M (2003) Neurologic complications of radiation therapy. Neurol Clin N Am 21(1):249–277

    Google Scholar 

  3. Gonzales J, Kumar AJ, Conrad CA, Levin VA (2007) Effect of bevacizumab on radiation necrosis of the brain. Int J Radiat Oncol Biol Phys 67(2):323–326. doi:10.1016/j.ijrobp.2006.10.010

    Google Scholar 

  4. Brandes A, Tosoni A, Spagnolli F, Frezza G, Leonardi M, Calbucci F, Franceschi E (2008) Disease progression after concomitant radiochemotherapy treatment: pitfalls in neurooncology. Neuro-oncol 10(3):361–367. doi:10.1215/15228517-2008-008

    Article  PubMed  Google Scholar 

  5. Ricci P, Karis J, Heiserman J, Fram EK, Bice AN, Drayer BP (1998) Differentiating recurrent tumor from radiation necrosis: time for re-evaluation of positron emission tomography? AJNR Am J Neuroradiol 19(3):407–413

    PubMed  CAS  Google Scholar 

  6. McPherson C, Warnick R (2004) Results of contemporary surgical management of radiation necrosis using frameless stereotaxis and intraoperative magnetic resonance imaging. J Neurooncol 68(1):41–47. doi:10.1023/B:NEON.0000024744.16031.e9

    Article  PubMed  Google Scholar 

  7. Chuba P, Aronin P, Bhambhani K, Eichenhorn M, Zamarano L, Cianci P, Mulbauer M, Porter AT, Fontanesi J (1997) Hyperbaric oxygen therapy for radiation induced brain injury in children. Cancer 80(10):2005–2012. doi:10.1002/(SICI)1097-0142(19971115)80:10<2005::AID-CNCR19>3.0.CO;2-0

    Article  PubMed  CAS  Google Scholar 

  8. Leber KA, Eder HG, Kovac H, Anegg U, Pendl G (1998) Treatment of cerebral radionecrosis by hyperbaric oxygen therapy. Stereotact Funct Neurosurg 70(suppl 1):229–236. doi:10.1159/000056426

    Article  PubMed  Google Scholar 

  9. Glantz MJ, Burger PC, Friedman AH, Radtke RA, Massey EW, Schold SC Jr (1994) Treatment of radiation-induced nervous system injury with heparin and warfarin. Neurology 44(11):2020–2027

    PubMed  CAS  Google Scholar 

  10. Macdonald DR, Cascino TL, Schold SC Jr, Cairncross JG (1990) Response criteria for phase II studies of supratentorial malignant glioma. J Clin Oncol 8:1277–1280

    PubMed  CAS  Google Scholar 

  11. Corn BW, Yousem DM, Scott CB, Rotman M, Asbell SO, Nelson DF, Martin L, Curran WJ Jr (1994) White matter changes are correlated significantly with radiation dose Observations from a randomized dose-escalation trial for malignant glioma (Radiation Therapy Oncology Group 83-02). Cancer 74(10):2828–2835. doi:10.1002/1097-0142(19941115)74:10<2828::AID-CNCR2820741014>3.0.CO;2-K

    Article  PubMed  CAS  Google Scholar 

  12. Levin VA, Yung WK, Bruner J, Kyritsis A, Leeds N, Gleason MJ, Hess KR, Meyers CA, Ictech SA, Chang E, Maor MH (2002) Phase II study of accelerated fractionation radiation therapy with carboplatin followed by PCV chemotherapy for the treatment of anaplastic gliomas. Int J Radiat Oncol Biol Phys 53(1):58–66. doi:10.1016/S0360-3016(01)02819-X

    PubMed  CAS  Google Scholar 

  13. Jain R, Scarpace L, Ellika S, Schultz LR, Rock JP, Rosenblum ML, Patel SC, Lee TY, Mikkelsen T (2007) First-pass perfusion computed tomography: initial experience in differentiating recurrent brain tumors from radiation effects and radiation necrosis. Neurosurgery 61(4):778–787

    Article  PubMed  Google Scholar 

  14. Ruben JD, Dally M, Bailey M, Smith R, McLean CA, Fedele P (2006) Cerebral radiation necrosis: incidence, outcomes, and risk factors with emphasis on radiation parameters and chemotherapy. Int J Radiat Oncol Biol Phys 65(2):499–508. doi:10.1016/j.ijrobp.2005.12.002

    PubMed  Google Scholar 

  15. Peterson K, Clark HB, Hall WA, Truwit CL (1995) Multifocal enhancing magnetic resonance imaging lesions following cranial irradiation. Ann Neurol 38(2):237–244. doi:10.1002/ana.410380217

    Article  PubMed  CAS  Google Scholar 

  16. Glantz MJ, Choy H, Kearns CM, Cole BF, Mills P, Zuhowski EG, Saris S, Rhodes CH, Stopa E, Egorin MJ (1996) Phase I study of weekly outpatient paclitaxel and concurrent cranial irradiation in adults with astrocytomas. J Clin Oncol 14(2):600–609

    PubMed  CAS  Google Scholar 

  17. Chamberlain MC, Glantz MJ, Chalmers L, Van Horn A, Sloan AE (2007) Early necrosis following concurrent Temodar and radiotherapy in patients with glioblastoma. J Neurooncol 82:81–83. doi:10.1007/s11060-006-9241-y

    Article  PubMed  Google Scholar 

  18. Kumar AJ, Leeds NE, Fuller GN, Van Tassel P, Maor MH, Sawaya RE, Levin VA (2000) Malignant gliomas: MR imaging spectrum of radiation therapy- and chemotherapy-induced necrosis of the brain after treatment. Radiology 217(2):377–384

    PubMed  CAS  Google Scholar 

  19. Cheng KM, Chan CM, Fu YT, Ho LC, Cheung FC, Law CK (2001) Acute hemorrhage in late radiation necrosis of the temporal lobe: report of five cases and review of the literature. J Neurooncol 51(2):143–150. doi:10.1023/A:1010631112015

    Article  PubMed  CAS  Google Scholar 

  20. Kim JH, Chung YG, Kim CY, Kim HK, Lee HK (2004) Upregulation of VEGF and FGF2 in normal rat brain after experimental intraoperative radiation therapy. J Korean Med Sci 19(6):879–886

    Article  PubMed  CAS  Google Scholar 

  21. Li Y-Q, Ballinger JR, Nordal RA, Su ZF, Wong CS (2001) Hypoxia in radiation-induced blood-spinal cord barrier breakdown. Cancer Res 61:3348–3354

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Hermelin Brain Tumor Center, Department of Neurosurgery, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA

    Roy Torcuator, Richard Zuniga, Yedathore S. Mohan, Jack Rock, Mark Rosenblum & Tom Mikkelsen

  2. Department of Medical Oncology, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA

    Thomas Doyle & Joseph Anderson

  3. Department of Pathology, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA

    Jorge Gutierrez

  4. Department of Radiation Oncology, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA

    Samuel Ryu

  5. Department of Neuro-Radiology, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA

    Rajan Jain

Authors
  1. Roy Torcuator
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Richard Zuniga
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yedathore S. Mohan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jack Rock
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thomas Doyle
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Joseph Anderson
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jorge Gutierrez
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Samuel Ryu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Rajan Jain
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Mark Rosenblum
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Tom Mikkelsen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Roy Torcuator.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Torcuator, R., Zuniga, R., Mohan, Y.S. et al. Initial experience with bevacizumab treatment for biopsy confirmed cerebral radiation necrosis. J Neurooncol 94, 63–68 (2009). https://doi.org/10.1007/s11060-009-9801-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-009-9801-z

Keywords

Search

Navigation