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An analysis of radiation necrosis of the central nervous system treated with bevacizumab

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Abstract

Radiation necrosis is a devastating complication following radiation to the central nervous system. The purpose of this study was to perform a comprehensive analysis of cases in the literature using bevacizumab, a monoclonal antibody against vascular endothelial growth factor, as treatment for radiation necrosis. A MEDLINE/PubMed search of articles about the use of bevacizumab for radionecrosis treatment yielded 16 studies published between 2007 and 2012. Data was summarized according to patient characteristics, treatment received and outcomes measured. A total of 71 unique cases were identified that met the inclusion criteria. The median age at the time of treatment with bevacizumab was 47 years. The most common tumors treated were glioblastoma (31 %), anaplastic glioma (14 %), and metastatic brain tumors (15 %). The median time from ending radiotherapy to starting treatment with bevacizumab was 11 months and the median follow up time after bevacizumab treatment was 8 months. The median number of cycles of bevacizumab was administered was 4, and the median dosage of bevacizumab was 7.5 mg/kg. The median time elapsed between cycles of bevacizumab was 2 weeks. Overall, pre and post treatment imaging revealed a median decrease in T1 contrast enhancement of 63 %, and a 59 % median decrease in T2/FLAIR signal abnormality. Treatment with bevacizumab resulted in a significant radiographic response for patients with radionecrosis. The median dosage of bevacizumab of 7.5 mg/kg for four cycles every 2 weeks should be considered as a treatment option in this patient population.

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Conflict of interest

The authors’ report that Dr. Kelly Nicholas is a consultant for Genentech.

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Authors and Affiliations

  1. Department of Radiation Oncology, University of Illinois at Chicago, 1801 West Taylor Street, Chicago, IL, 60612, USA

    Karen Tye, Ralph R. Weichselbaum & Matthew Koshy

  2. Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA

    Herbert H. Engelhard & Konstantin V. Slavin

  3. Department of Neurology, The University of Chicago, Chicago, IL, USA

    M. Kelly Nicholas

  4. Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL, USA

    Steven J. Chmura, Ralph R. Weichselbaum & Matthew Koshy

  5. Department of Radiation Oncology, University of Maryland, Baltimore, MD, USA

    Young Kwok

  6. Department of Medical Oncology, University of Illinois at Chicago, Chicago, IL, USA

    Dominic S. Ho

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  1. Karen Tye
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Correspondence to Matthew Koshy.

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Tye, K., Engelhard, H.H., Slavin, K.V. et al. An analysis of radiation necrosis of the central nervous system treated with bevacizumab. J Neurooncol 117, 321–327 (2014). https://doi.org/10.1007/s11060-014-1391-8

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  • DOI: https://doi.org/10.1007/s11060-014-1391-8

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