Changes in Protein Level in the Cerebrospinal Fluid of a Patient with Cerebral Radiation Necrosis Treated with Bevacizumab

Yano, Hirohito; Nakayama, Noriyuki; Morimitsu, Kasumi; Futamura, Manabu; Ohe, Naoyuki; Miwa, Kazuhiro; Shinoda, Jun; Iwama, Toru

doi:10.4137/cmo.s19823

Cited by 5 publications

(8 citation statements)

References 23 publications

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“…The ability of bevacizumab to reduce CSF protein levels and facilitate VP-shunt placement was first described in an adult case with hydrocephalus caused by radionecrosis for the treatment of anaplastic astrocytoma. 12 Our study has now described bevacizumab treatment in children with low-grade gliomas with hydrocephalus and high levels of CSF proteins with the aim to reduce CSF protein levels.…”

Section: Discussionmentioning

confidence: 99%

“…9,10 Recently, it has been used to improve vision in children with OPG, 11 and cases have been reported that suggest its efficacy to decrease CSF protein concentration in radiation necrosis context. 12 OPG are known to cause elevated CSF protein concentrations. 7 We report two patients with OPG and high CSF protein levels that underwent bevacizumab treatment.…”

Section: Introductionmentioning

confidence: 99%

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Reduction in the cerebrospinal fluid protein level after bevacizumab treatment in patients with optic pathway low‐grade gliomas

Costa

Watanabe

Soares

et al. 2022

Pediatric Blood & Cancer

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Optic pathway gliomas (OPG) can cause elevated cerebrospinal fluid (CSF) protein concentrations. We report on two patients with suprasellar low-grade gliomas and high CSF protein levels (590 and 551 mg/dl) that precluded shunt implantation. After two and three doses of bevacizumab, respectively, the levels dropped dramatically to 191 and 178 mg/dl, respectively. Bevacizumab treatment was associated with a decrease in CSF protein level, allowing successful shunt placement. Our results are consistent with the pharmacological mechanism of bevacizumab, which decreases protein leakage from blood vessels to the ventricles.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reduction in the cerebrospinal fluid protein level after bevacizumab treatment in patients with optic pathway low‐grade gliomas

Costa

Watanabe

Soares

et al. 2022

Pediatric Blood & Cancer

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“…Furthermore, a study on mice showed that BEV not only inhibited angiogenesis but also enhanced the cytotoxicity of cisplatin and promoted apoptosis of tumor cells as a chemosensitizer [38]. It has also been found that low-dose BEV can also be used to treat brain edema due to radiotherapy [39].…”

Section: Discussionmentioning

confidence: 99%

Bevacizumab for non-small cell lung cancer patients with brain metastasis: A meta-analysis

et al. 2020

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AbstractThis study evaluates the efficacy and safety of bevacizumab (BEV) in the treatment of non-small cell lung cancer (NSCLC) patients with brain metastases (BM) by performing meta-analyses of response and survival indices. Seventeen studies were included. BEV treatment was associated with a lower new BM incidence (hazard ratio: 0.30 [95% confidence interval (CI): 0.14, 0.46]) during follow-up. Disease control rate (DCR) of BEV-treated patients with BM was 91% [95% CI: 85, 95]. However, intracranial DCR was relatively higher (94% [95% CI: 87, 98]) than extracranial DCR (86% [95% CI: 74, 96]). DCR of NSCLC patients with BM was significantly better with BEV than with control therapies (odds ratio: 2.71 [95% CI: 1.26, 5.86], P = 0.01). Progression-free survival (PFS) of BEV-treated patients with and without BM was 7.1 months [95% CI: 6.2, 8.0] and 7.4 months [95% CI: 6.3, 8.4], respectively. Intracranial PFS of BEV-treated patients with BM was 8.0 months [95% CI: 6.0, 10.0]. Overall survival of BEV-treated NSCLC patients with and without BM was 13.5 months [95% CI: 11.4, 15.6] and 12.5 months [95% CI: 10.2, 14.8], respectively. The incidence of bleeding/hemorrhage in the central nervous system was 1% with BEV treatment.

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“…Radiation necrosis is proposed to occur due to vascular damage and proliferation, therefore bevacizumab, an angiogenesis inhibitor, treats the underlying cause of symptom manifestation [12]. Bevacizumab has been shown to reduce angiogenesis in patients thereby limiting edema and proteinopathies around the radiation site [18]. Bevacizumab can limit prolonged dexamethasone therapy.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic radiosurgery planning based on time-resolved CTA for arteriovenous malformation: a case report and review of the literature

et al. 2016

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Stereotactic radiosurgery has long been recognized as the optimal form of management for high-grade arteriovenous malformations not amenable to surgical resection. Radiosurgical plans have generally relied upon the integration of stereotactic magnetic resonance angiography (MRA), standard contrast-enhanced magnetic resonance imaging (MRI), or computed tomography angiography (CTA) with biplane digital subtraction angiography (DSA). Current options are disadvantageous in that catheter-based biplane DSA is an invasive test associated with a small risk of complications and perhaps more importantly, the two-dimensional nature of DSA is an inherent limitation in creating radiosurgical contours. The necessity of multiple scans to create DSA contours for radiosurgical planning puts patients at increased risk. Furthermore, the inability to import two-dimensional plans into some radiosurgery programs, such as Cyberknife TPS, limits treatment options for patients. Defining the nidus itself is sometimes difficult in any of the traditional modalities as all draining veins and feeding arteries are included in the images. This sometimes necessitates targeting a larger volume, than strictly necessary, with stereotactic radiosurgery for treatment of the AVM. In this case report, we show the ability to use a less-invasive and three-dimensional form of angiography based on time-lapsed CTA (4D-CTA) rather than traditional DSA for radiosurgical planning. 4D-CTA may allow generation of a series of images, which can show the flow of contrast through the AVM. A review of these series may allow the surgeon to pick and use a volume set that best outlines the nidus with least interference from feeding arteries or draining veins. In addition, 4D-CTA scans can be uploaded into radio-surgery programs and allow three-dimensional targeting. This is the first reported case demonstrating the use of a 4D CTA and an MRI to delineate the AVM nidus for Gamma Knife radiosurgery, with complete obliteration of the nidus over time and subsequent management of associated radiation necrosis with bevacizumab.

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Changes in Protein Level in the Cerebrospinal Fluid of a Patient with Cerebral Radiation Necrosis Treated with Bevacizumab

Cited by 5 publications

References 23 publications

Reduction in the cerebrospinal fluid protein level after bevacizumab treatment in patients with optic pathway low‐grade gliomas

Reduction in the cerebrospinal fluid protein level after bevacizumab treatment in patients with optic pathway low‐grade gliomas

Bevacizumab for non-small cell lung cancer patients with brain metastasis: A meta-analysis

Stereotactic radiosurgery planning based on time-resolved CTA for arteriovenous malformation: a case report and review of the literature

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