Effect of prophylactic hyperbaric oxygen treatment for radiation-induced brain injury after stereotactic radiosurgery of brain metastases

Ohguri, Takayuki; Imada, Hajime; Kohshi, Kiyotaka; Kakeda, Shingo; Ohnari, Norihiro; Morioka, Tomoaki; Nakano, Kazushi; Konda, Nobuhide; Korogi, Yukunori

doi:10.1016/j.ijrobp.2006.08.009

Cited by 69 publications

(32 citation statements)

References 33 publications

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“…Pearlstein [52]. They found that prophylactic HBO with SRS may be associated with decreased peritumoral edema, but they did not evaluate for global white matter changes.…”

Section: Discussionmentioning

confidence: 99%

Leukoencephalopathy After Stereotactic Radiosurgery for Brain Metastases

Trifiletti

Lee²,

Schlesinger

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

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“…Pearlstein [52]. They found that prophylactic HBO with SRS may be associated with decreased peritumoral edema, but they did not evaluate for global white matter changes.…”

Section: Discussionmentioning

confidence: 99%

Leukoencephalopathy After Stereotactic Radiosurgery for Brain Metastases

Trifiletti

Lee²,

Schlesinger

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

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“…Also, poor patient response to conventional steroid dosages has been previously observed, including adverse effects such as behavioral changes, altered sleep patterns and changes in appetite. Recent research suggests that therapeutic anticoagulation and hyperbaric oxygen therapy may provide some relief of these symptoms, but the efficacy of these treatments is still controversial [1]. Alternatively, surgical decompression of radiation necrosis lesions can provide a beneficial palliative effect; however, this treatment does not reverse the necrotic process in the majority of patients [2].…”

Section: Introductionmentioning

confidence: 99%

Reversal of cerebral radiation necrosis with bevacizumab treatment in 17 Chinese patients

et al. 2012

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BackgroundBevacizumab has been suggested as a new treatment modality for cerebral radiation necrosis due to its ability to block the effects of vascular endothelial growth factor (VEGF) in leakage-prone capillaries, though its use still remains controversial in clinical practice.MethodsThe use of bevacizumab in 17 patients with symptomatic cerebral radiation necrosis poorly controlled with dexamethasone steroid treatments was examined between March 2010 and January 2012. Bevacizumab therapy was administered for a minimum of two cycles (7.5 mg/kg, at two-week interval) with a median of four bevacizumab injections. Changes in bi-dimensional measurements of the largest radiation necrosis lesions were observed by gadolinium-enhanced and T2-weighted magnetic resonance imaging (MRI). Additionally, dexamethasone dosage, Karnofsky performance status (KPS), adverse event occurrence and associated clinical outcomes were recorded for each patient.ResultsMRI analysis revealed that the average reduction was 54.9% and 48.4% in post-gadolinium and T2-weighted sequence analysis, respectively. Significant clinical neurological improvements were expressed in 10 patients according to KPS values. Dexamethasone reduction was achieved four weeks after initiation of bevacizumab in all patients, with four patients successfully discontinuing dexamethasone treatment. Mild to moderate bevacizumab-related adverse events, such as fatigue, proteinuria and hypertension were observed in three patients. Upon follow-up at 4 to 12 months, 10 patients showed clinical improvement, and 7 patient deaths occurred from tumor progression (5 patients), recurrent necrosis (1 patient), and uncontrolled necrosis-induced edema (1 patient).ConclusionsThese findings suggest bevacizumab as a promising treatment for cerebral radiation necrosis induced by common radiation therapies, including external beam radiotherapy (EBRT), stereotactic radiosurgery (SRS), and fractionated stereotactic radiotherapy (FSRT).

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“…High-dose radiation treatments may have potential for greater rates of tumor control [2][3][4][5][6], but this is typically at the expense of greater rates of RN within the treatment volume. Also, stereotactic radiosurgery (SRS) achieves good control over metastatic brain tumors with the risk of RN [7]. Medical therapy is often started first and surgery reserved for use only if the lesion is refractory, unless there is an increase in symptomatic intracranial pressure [8,9].…”

Section: Introductionmentioning

confidence: 99%

The distribution of vascular endothelial growth factor-producing cells in clinical radiation necrosis of the brain: pathological consideration of their potential roles

et al. 2011

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The cell type and localization of vascular endothelial growth factor (VEGF)-producing cells in human radiation necrosis (RN) are investigated from a histopathological and immunohistochemical standpoint using clinical specimens. Eighteen surgical specimens of symptomatic RN in the brain were retrospectively reviewed. These cases included different original histological tumor types and were treated with different radiation modalities. Histological analyses were performed using hematoxylin and eosin (H&E) staining, and anti-VEGF and anti-hypoxia-inducible factor (HIF)-1α immunohistochemistry. H&E staining showed marked angiogenesis and reactive astrocytosis at the perinecrotic area. The most prominent vasculature in this area was identified as telangiectasis. Immunohistochemistry indicated that HIF-1α was expressed predominantly in the perinecrotic area and that a large majority of VEGF-expressing cells were reactive astrocytes intensively distributed in this area. VEGF produced by the reactive astrocytes localized mainly in the perinecrotic area might be a major cause of both angiogenesis and the subsequent perilesional edema typically found in RN of the brain. The benefits of anti-VEGF antibody (bevacizumab) treatment in RN may be that VEGF secretion from the perinecrotic tissue is inhibited and that surgery would remove this tissue; both of these benefits result in effective reduction of edema associated with RN.

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Effect of prophylactic hyperbaric oxygen treatment for radiation-induced brain injury after stereotactic radiosurgery of brain metastases

Cited by 69 publications

References 33 publications

Leukoencephalopathy After Stereotactic Radiosurgery for Brain Metastases

Leukoencephalopathy After Stereotactic Radiosurgery for Brain Metastases

Reversal of cerebral radiation necrosis with bevacizumab treatment in 17 Chinese patients

The distribution of vascular endothelial growth factor-producing cells in clinical radiation necrosis of the brain: pathological consideration of their potential roles

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