Single low-dose targeted bevacizumab infusion in adult patients with steroid-refractory radiation necrosis of the brain: a phase II open-label prospective clinical trial

Dashti, Shervin R.; Kadner, Robert J.; Folley, Bradley S.; Sheehan, Jason P.; Han, Deping; Carter, Mary B; Shields, Lisa B. E.; Plato, Brian M.; Rocca, Renato V. La; Spalding, Aaron C.; Yao, Tom L; Fraser, Justin F.

doi:10.3171/2022.2.jns212006

Cited by 8 publications

(59 citation statements)

References 39 publications

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“…Two non-randomized studies were published in 2022, 13,14 2 non-randomized studies were published in 2021, 15,16 1 non-randomized study was published in 2017, 17 and 1 non-randomized study was published in 2016. 18 Four of the non-randomized studies were single-arm retrospective cohort studies that used historical patient data to compare the change in outcomes before and after treatment.…”

Section: Methodsmentioning

confidence: 99%

“…13,[15][16][17] Two of the non-randomized studies were single-arm prospective cohort studies that collected patient data prospectively to compare the change in outcomes before and after treatment. 14,18 When reported, patient follow-up times varied across each study, but ranged from 6 months to 14.2 months.…”

Section: Methodsmentioning

confidence: 99%

“…Four SRs 9-12 including 1 with meta-analysis 9 and 6 non-randomized studies [13][14][15][16][17][18] were included in this report.…”

Section: Summary Of Study Characteristicsmentioning

confidence: 99%

“…The included SRs were conducted in China, 9,10 Italy, 11 and the US. 12 The included non-randomized studies were conducted in Canada, 13 the US, 14 China, [15][16][17] and Japan. 18…”

Section: Country Of Originmentioning

confidence: 99%

“…[9][10][11][12] Each non-randomized study included patients who had undergone radiosurgery, were diagnosed with brain radionecrosis, and were subsequently treated with bevacizumab. [13][14][15][16][17][18] The number of patients included in each non-randomized study ranged from 10 to 40, and the mean or median age of patients ranged from 35.1 years to 64 years. [13][14][15][16][17][18]…”

Section: Patient Populationmentioning

confidence: 99%

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Bevacizumab for the Treatment of Patients With Brain Radionecrosis

Hill¹,

MacDougall²

2022

cjht

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This review identified limited evidence regarding the clinical effectiveness and safety of bevacizumab for patients with symptomatic brain radionecrosis after radiosurgery. These identified studies had several limitations, most notably due to the limited number of studies with control groups; therefore, the findings related to the effectiveness and safety in this population are uncertain. For adult patients with symptomatic brain radionecrosis, treatment with bevacizumab may be associated with radiographic responses, a reduction in volumetric outcomes, an improvement in overall clinical and neurologic symptoms, an improvement in functional outcomes, and a reduction in corticosteroid use. Limited evidence from 1 study suggests that treatment with bevacizumab may be associated with greater radiographic response, a reduction in volumetric outcomes, and clinical symptom improvement compared to treatment with corticosteroids. The recurrence of brain radionecrosis for patients who received bevacizumab compared to corticosteroids was similar between groups. Commonly reported adverse events after patients with symptomatic brain radionecrosis were treated with bevacizumab included hypertension, proteinuria, edema, pulmonary embolism, and various thromboembolic events.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…Four SRs 9-12 including 1 with meta-analysis 9 and 6 non-randomized studies [13][14][15][16][17][18] were included in this report.…”

Section: Summary Of Study Characteristicsmentioning

confidence: 99%

“…The included SRs were conducted in China, 9,10 Italy, 11 and the US. 12 The included non-randomized studies were conducted in Canada, 13 the US, 14 China, [15][16][17] and Japan. 18…”

Section: Country Of Originmentioning

confidence: 99%

Section: Patient Populationmentioning

confidence: 99%

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Bevacizumab for the Treatment of Patients With Brain Radionecrosis

Hill¹,

MacDougall²

2022

cjht

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Bevacizumab reduces peritumoral brain edema in lung cancer brain metastases after radiotherapy

Hua,

Gao,

Wang

et al. 2023

Thoracic Cancer

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BackgroundThe aim of this study was to investigate the efficacy of bevacizumab (Bev) in reducing peritumoral brain edema (PTBE) after stereotactic radiotherapy (SRT) for lung cancer brain metastases.MethodsA retrospective analysis was conducted on 44 patients with lung cancer brain metastases (70 lesions) who were admitted to our oncology and Gamma Knife center from January 2020 to May 2022. All patients received intracranial SRT and had PTBE. Based on treatment with Bev, patients were categorized as SRT + Bev and SRT groups. Follow‐up head magnetic resonance imaging was performed to calculate PTBE and tumor volume changes. The edema index (EI) was used to assess the severity of PTBE. Additionally, the extent of tumor reduction and intracranial progression‐free survival (PFS) were compared between the two groups.ResultsThe SRT + Bev group showed a statistically significant difference in EI values before and after radiotherapy (p = 0.0115), with lower values observed after treatment, but there was no difference in the SRT group (p = 0.4008). There was a difference in the distribution of EI grades in the SRT + Bev group (p = 0.0186), with an increased proportion of patients at grades 1–2 after radiotherapy, while there was no difference in the SRT group (p > 0.9999). Both groups demonstrated a significant reduction in tumor volume after radiotherapy (p < 0.05), but there was no difference in tumor volume changes between the two groups (p = 0.4089). There was no difference in intracranial PFS between the two groups (p = 0.1541).ConclusionBevacizumab significantly reduces the severity of PTBE after radiotherapy for lung cancer. However, its impact on tumor volume reduction and intracranial PFS does not reach statistical significance.

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Clinical and radiological effects of Bevacizumab for the treatment of radionecrosis after stereotactic brain radiotherapy

Zoto Mustafayev,

Turna,

Bolukbasi

et al. 2024

BMC Cancer

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Purpose The purpose of this multicenter retrospective study was to analyze the clinical and radiological effects of bevacizumab (BV) on radionecrosis (RN) that developed after stereotactic radiotherapy (SRT) for brain metastasis. Methods Forty patients with SRT related symptomatic brain RN treated in 10 radiation oncology centers were analyzed. The clinical response to BV treatment was categorized as follows: complete (no additional treatment required), partial (requiring either steroids or repeat BV), and unresponsive (requiring surgery). The radiological features of brain RN were analyzed in 10 patients whose serial MRI scans were available after corticosteroid and BV treatments. Results BV was used as a first line treatment in 11 (27.5%) and as a second line treatment in 29 (72.5%) of patients. The neurological symptoms regressed in 77.5% of patients after treatment with BV (45% complete response, 32.5% partial response). The median edema volume increased from 75.9 cc (range: 5.9-125.8 cc) at RN to 113.65 cc (range: 1.5-382.1 cc) after use of corticosteroids, representing a rate of 39.8% increase (p = 0.074). However, after BV treatment the median volume of edema decreased to 19.5 cc (range: 0-163.3 cc) which represents a difference of 62.2% (p = 0.041) from RN. Conclusion The use of BV caused clinical response rate of 77.5% and a good radiological response in corticosteroid unresponsive patients. The role of BV should be further investigated in prospective studies.

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Single low-dose targeted bevacizumab infusion in adult patients with steroid-refractory radiation necrosis of the brain: a phase II open-label prospective clinical trial

Cited by 8 publications

References 39 publications

Bevacizumab for the Treatment of Patients With Brain Radionecrosis

Bevacizumab for the Treatment of Patients With Brain Radionecrosis

Bevacizumab reduces peritumoral brain edema in lung cancer brain metastases after radiotherapy

Clinical and radiological effects of Bevacizumab for the treatment of radionecrosis after stereotactic brain radiotherapy

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