Bevacizumab for Cerebral Radionecrosis: A Single-Center Experience

被引:4
|
作者
Climans, Seth A. [1 ,2 ,3 ,4 ]
Ramos, Ronald C. [1 ,2 ,3 ]
Jablonska, Paola A. [5 ]
Shultz, David B. [5 ]
Mason, Warren P. [1 ,2 ,3 ]
机构
[1] Princess Margaret Canc Ctr, Dept Neurol, Toronto, ON, Canada
[2] Princess Margaret Canc Ctr, Dept Med Oncol, Toronto, ON, Canada
[3] Princess Margaret Canc Ctr, Dept Hematol, Toronto, ON, Canada
[4] London Hlth Sci Ctr, Dept Oncol, London, ON, Canada
[5] Princess Margaret Canc Ctr, Dept Radiat Oncol, Toronto, ON, Canada
关键词
Radiotherapy; Radionecrosis; Bevacizumab; Brain metastasis; Meningioma; RADIATION NECROSIS; SAFETY;
D O I
10.1017/cjn.2022.64
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background: Cerebral radionecrosis, a subacute or late effect of radiotherapy, can be debilitating and difficult to treat. Steroids can reduce symptoms, but have significant long-term side effects. Bevacizumab has been shown to reduce edema and other radiologic features associated with radionecrosis and improve patient symptoms. We report our experience using bevacizumab for cerebral radionecrosis. Methods: We retrospectively reviewed the charts of all patients treated at our institution with bevacizumab for non-glioma-associated cerebral radionecrosis. We recorded change in symptoms, change in steroids, change in performance status, time to tumor progression, and time to death. We delineated the volume of necrosis pre- and post-bevacizumab on T1-post-gadolinium and fluid-attenuated inversion recovery (FLAIR) MRI scans. Results: We identified 15 patients, 8 with brain metastases, 6 with meningioma, and 1 with nasopharyngeal carcinoma. Most received four doses of bevacizumab, 7.5 mg/kg q 3 weeks x 4 doses. Neuroimaging demonstrated a reduced T1 gadolinium-enhancing volume and edema in 14/15 patients (the average reduction in T1-post-gadolinium volume was 3.0 cm(3), and average reduction in FLAIR volume was 27.9 cm(3)). There was no appreciable change in patient performance status. Steroid doses decreased in five of nine patients. There was a high rate (26%) of adverse events, including pulmonary embolism, stroke, and wound dehiscence. The median progression-free survival was 6.5 months. Conclusion: Although bevacizumab is commonly prescribed for cerebral radionecrosis, in our retrospective cohort, the clinical benefits were modest and there was significant toxicity.
引用
收藏
页码:573 / 578
页数:6
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