Initial experience with bevacizumab treatment for biopsy confirmed cerebral radiation necrosis

Torcuator, Roy; Zuniga, Richard; Mohan, Yedathore S.; Rock, Jack; Doyle, Thomas J.; Anderson, Joseph M; Gutiérrez, Jorge; Ryu, Samuel; Jain, Rajan; Rosenblum, Mark L.; Mikkelsen, Tom

doi:10.1007/s11060-009-9801-z

Cited by 180 publications

(109 citation statements)

References 19 publications

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“…29 Recent reports suggesting that anti-VEGF therapy can be used in patients with radiation necrosis supports the role played by VEGF signaling cascade in radiation injury. 30,31 Vascular Perfusion Parameters in Differentiating TIN from RPT Blood volume estimates obtained by using MR 8,11,27 or PCT 7 techniques have been previously used with significant success in differentiating the 2 entities. Blood volume estimates are based on the differences in vascularity of the 2 entities, with recurrent tumors showing high blood volume due to tumor angiogenesis and increased vascular density; whereas radiation necrosis shows low blood volume because it consists primarily of hyalinized vasculopathy and coagulative necrosis, leading to hypoperfusion.…”

Section: Practical Problems Using Permeability Estimates Tomentioning

confidence: 99%

Permeability Estimates in Histopathology-Proved Treatment-Induced Necrosis Using Perfusion CT: Can These Add to Other Perfusion Parameters in Differentiating from Recurrent/Progressive Tumors?

Jain¹,

Narang²,

Schultz³

et al. 2011

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Differentiating treatment effects from RPT is a common yet challenging task in a busy neuro-oncologic pratice. PS probably represents a different aspect of angiogenesis and vasculature and can provide additional physiologic information about recurrent/progressive enhancing lesions. The purpose of the study was to use PS measured by using PCT to differentiate TIN from RPT in patients with previously irradiated brain tumor who presented with a recurrent/progressive enhancing lesion.

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Section: Practical Problems Using Permeability Estimates Tomentioning

confidence: 99%

Permeability Estimates in Histopathology-Proved Treatment-Induced Necrosis Using Perfusion CT: Can These Add to Other Perfusion Parameters in Differentiating from Recurrent/Progressive Tumors?

Jain¹,

Narang²,

Schultz³

et al. 2011

AJNR Am J Neuroradiol

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“…6 In our case, biphasic clinical course was seen and loss of strength in the left upper limb occurred following 2 years after the first attack of radiotherapy. The second attack occurred 6 years after diagnosis, patients had loss of strength in four of her limbs.…”

mentioning

confidence: 46%

“…Bevacizumab as an anti-VEGF, has shown efficacy in treating central radionecrosis. 5,6 Seventy-one cerebral necrosis patients treated with 4 cycles of International Journal of Hematology and Oncology bevacizumab. Bevacizumab was well tolerated by patients and showed efficacy in the treatment of radiation necrosis.…”

mentioning

confidence: 99%

Targeted Therapies are New Hope for Patients with Spinal Radionecrosis.

Hocazade¹,

Özdemir²,

Yazıcı³

et al. 2016

UHOD

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“…The mainstay of treatment is high-dose corticosteroids, which themselves generate a litany of poorly-tolerated symptoms, including hyperglycemia, elevated infection risk, impaired wound healing, osteopenia and suppressed adrenal function [9]. Alternative strategies such as therapeutic anticoagulation, bevacizumab [10], hyperbaric oxygen [11], and even resection [7] have been attempted with limited success, and AIRS remains a substantial therapeutic challenge.…”

Section: Introductionmentioning

confidence: 99%

Laser Interstitial Thermal Therapy for Radiation Necrosis/Adverse Inflammatory Responses to SRS - Case Report and Literature Review

Tsvankin¹,

Howell²,

Fecci³

2017

JNSK

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Brain metastases are the most common type of intracranial tumor, and confer a dismal prognosis. Morbidity in these patients arises not only from tumor burden but from treatment-related toxicities. Among the most significant of these is radiation necrosis, a common sequelae of stereotactic radiosurgery that may cause neurologic impairment through mass effect or steroid-refractory edema. Truly, "radiation necrosis" is a misnomer, as the process is more accurately an adverse inflammatory response post-stereotactic radiotherapy (AIRS). Because it is impossible to reliably distinguish AIRS from tumor recurrence without a biopsy, and because high-dose steroids are poorly tolerated, management of AIRS poses a significant therapeutic challenge. Laser interstitial thermal therapy (LITT) is an emerging minimally-invasive treatment modality which uses hyperthermia to ablate intracranial pathologic tissues. Here, we describe the use of LITT in a patient with steroid-refractory AIRS following radiosurgery for a right supplementary motor area metastatic focus, and provide a brief review of the utility of LITT in patients with AIRS. direct heat application across the lesion volume, resulting in controlled cell death [30]. In contrast to open surgery, LITT can be performed through the same basic operating platform as a biopsy, allowing the neurosurgeon to avoid the risk of performing a craniotomy. The incision is less than 1cm long; at our institution, patients do not require ICU admission postoperatively, and most are discharged either the same day or the following morning. The result is a minimally-morbid diagnostic and treatment option for patients with previously-treated intracranial tumors. Here, we offer an illustrative case and brief review of LITT application in the setting of AIRS. Citation Case ReportThe patient is a 66 year old right-handed female with a history of lung adenocarcinoma, initially diagnosed in January of 2014 when she presented with cough and hemoptysis. Surveillance imaging demonstrated a solitary 1cm metastasis of the right frontal lobe, and the patient was treated with Cyber Knife on 3/5/2014. She underwent concurrent chemoradiation with carboplatin/paclitaxel and 60Gy radiation to the right upper lung, mediastinum and SCV region (completed 4/16/2014), followed by an additional two cycles of chemotherapy (completed 5/20/2014). She was subsequently placed on erlotinib due to EGFR mutation, then switched to afatenib in September 2014.In July 2015 the patient noted a sense of imbalance and left hand weakness; an MRI demonstrated enlargement of the previously-treated brain metastasis at the posterior margin of the right superior frontal gyrus, with significant associated edema (Figure 1). She was started on dexamethasone, with some symptomatic improvement. Given her continued weakness, however, a plan was made for the patient to undergo stereotactic biopsy with possible subsequent LITT.On 10/12/2015 the patient was electively taken to the operating room. Using frameless stereotaxy, a biopsy was...

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Initial experience with bevacizumab treatment for biopsy confirmed cerebral radiation necrosis

Abstract: Bevacizumab appears to produce radiographic response and clinical benefits in the treatment of patients with cerebral radionecrosis.

Cited by 180 publications

References 19 publications

Permeability Estimates in Histopathology-Proved Treatment-Induced Necrosis Using Perfusion CT: Can These Add to Other Perfusion Parameters in Differentiating from Recurrent/Progressive Tumors?

Permeability Estimates in Histopathology-Proved Treatment-Induced Necrosis Using Perfusion CT: Can These Add to Other Perfusion Parameters in Differentiating from Recurrent/Progressive Tumors?

Targeted Therapies are New Hope for Patients with Spinal Radionecrosis.

Laser Interstitial Thermal Therapy for Radiation Necrosis/Adverse Inflammatory Responses to SRS - Case Report and Literature Review

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