Bevacizumab as a Treatment Option for Radiation-Induced Cerebral Necrosis

Abstract

Radiation necrosis of normal CNS tissue represents one of the main risk factors of brain irradiation, occurring more frequently and earlier at higher total doses and higher doses per fraction. At present, it is believed that the necrosis results due to increasing capillary permeability caused by cytokine release leading to extracellular edema. This process is sustained by endothelial dysfunction, tissue hypoxia, and subsequent necrosis. Consequently, blocking the vascular endothelial growth factor (VEGF) at an early stage could be an option to reduce the development of radiation necrosis by decreasing the vascular permeability. This might help to reverse the pathological mechanisms, improve the symptoms and prevent further progression. A patient with radiationinduced necrosis was treated with an anti-VEGF antibody (bevacizumab), in whom neurologic signs and symptoms improved in accordance with a decrease in T1-weighted fluid-attenuated inversion recovery signals. Our case report together with the current literature suggests bevacizumab as a treatment option for patients with symptoms and radiological signs of cerebral necrosis induced by radiotherapy.

Prolonged survival when temozolomide is added to accelerated radiotherapy for glioblastoma multiforme

“…Similar favorable results of fractionated stereotactic re-irradiation are documented in the literature [3,4,8,29]. More recent studies reported the integration of modern targeted chemotherapy into stereotactic re-irradiation and preliminary results are encouraging [10,17,25].…”

Impact of VEGF gene polymorphisms and haplotypes on radiation-induced late toxicity in prostate cancer patients

“…Recently, bevacizumab, an anti-VEGF antibody was found to be effective in treatment of radiation-induced cerebral necrosis leading to radiographic response and to an improvement of cerebral edema with reduction of steroid medication. In experimental models, blockage of the VEGF-related pathway was also shown to reduce radiation-induced fibrosis in rectal tissues [31,33,34,44].…”

Radiation-induced cranial neuropathy in patients with nasopharyngeal carcinoma

“…Radiotherapy is the mainstay of therapy for NPC and greatly improves patient survival [2]. Along with promising therapeutic effects, complications such as radiation dermatitis [3], temporal lobe necrosis, cognitive impairment, and cranial nerve injury are also associated with radiotherapy [4,5,6]. Reports in the literature have described that cranial nerves were relatively radioresistant, and palsy was a rare complication after radiotherapy [7,8,9].…”