Incidental Resolution of a Radiation-Induced Cavernous Hemangioma of the Brain following the Use of Bevacizumab in a Child with Recurrent Medulloblastoma

Abstract

Radiation-induced cavernous hemangiomas (RICH) are a known complication of radiation exposure, especially in young children. The current treatment approaches to these lesions include observation and surgical resection. We report the case of a 4-year-old male with recurrent medulloblastoma who had resolution of an incidental RICH lesion while being treated with bevacizumab for his recurrent brain tumor. There was no evidence of worsening hemorrhage with this therapy and the RICH did not recur upon discontinuation of the chemotherapy regimen. This is the first documented case of a RICH lesion responding to antiangiogenic therapy, suggesting the possible use of this class of agents in the treatment of symptomatic patients who are not considered appropriate candidates for surgical resection. Although the risk of bleeding must be taken into consideration, antiangiogenic therapies have the potential to be a novel treatment modality for symptomatic RICH lesions.

Durable response of intracranial cellular hemangioma to bevacizumab and temozolomide

“…7,12 For numerous cases, use of bevacizumab to treat primary malignancies has reportedly produced incidental resolution of visceral hemangioma. 4,12 Common side effects of bevacizumab include hypertension, bleeding, and proteinuria. Temozolomide is an oral alkylating agent that acts by methylating DNA, leading to DNA breakage and apoptosis in actively dividing cells.…”

Adjuvant role of anti-angiogenic drugs in the management of head and neck arteriovenous malformations

“…Intravenous Bevacizumab has been reported to be effective in the treatment of AVMs of patients with HHT, in radiation-induced cavernomas and in central nervous system hemangioblastomas [39][40][41][42]. Doses have ranged from 5 to 15 mg/kg IV every 2-3 weeks for 6-12 doses [37].…”

Late Cerebrovascular Complications After Radiotherapy for Childhood Primary Central Nervous System Tumors

“…For instance, narrowing of vascular vessel lumen, ischemia and micro-infarction could cause microbleeds, while neoangiogenesis due to hipoxy-induciblefactor-1 release and vascular endothelial growth factor (VEGF) expression could originate cavernomas (22, 23). Aguilera et al reported an incidental remission of RT induced cavernoma during therapy with bevacizumab (a monoclonal antibody directed against VEGF), in a single patient with relapsed medulloblastoma(24). The authors hypothesized that resolution of the cavernoma was related to bevacizumab anti-VEGF activity.Three cases of superficial siderosis and two ischemic strokes also occurred.…”