Single-shot bevacizumab for cerebral radiation injury

BMC Neurology

Martin Voss¹  Michael W. Ronellenfitsch¹  Joachim P. Steinbach¹  Marie-Thérèse Forster²  Emmanouil Fokas³  Katharina J. Wenger⁴ 

[1] Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany;University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany;German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, Frankfurt/Main, Germany;Frankfurt Cancer Institute (FCI), Georg-Speyer-Haus, Frankfurt/Main, Germany;University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany;German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, Frankfurt/Main, Germany;Frankfurt Cancer Institute (FCI), Georg-Speyer-Haus, Frankfurt/Main, Germany;Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany;University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany;German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, Frankfurt/Main, Germany;Frankfurt Cancer Institute (FCI), Georg-Speyer-Haus, Frankfurt/Main, Germany;Department of Radiotherapy and Oncology, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany;University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany;German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, Frankfurt/Main, Germany;Frankfurt Cancer Institute (FCI), Georg-Speyer-Haus, Frankfurt/Main, Germany;Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany;

关键词: Radiation necrosis;    Bevacizumab;    Dexamethasone;    Side effect;    Edema;   

DOI  :  10.1186/s12883-021-02103-0

来源: Springer

【 摘 要 】

BackgroundCerebral radiation injury, including subacute radiation reactions and later stage radiation necrosis, is a severe side effect of brain tumor radiotherapy. A protocol of four infusions of the monoclonal antibody bevacizumab has been shown to be a highly effective treatment. However, bevacizumab is costly and can cause severe complications including thrombosis, bleeding and gastrointestinal perforations.MethodsWe performed a retrospective analysis of patients treated in our clinic for cerebral radiation injury who received only a singular treatment with bevacizumab. Single-shot was defined as a singular administration of bevacizumab without a second administration during an interval of at least 6 weeks.ResultsWe identified 11 patients who had received a singular administration of bevacizumab to treat cerebral radiation injury. Prior radiation had been administered to treat gliomas (ten patients) or breast cancer brain metastases (one patient). 9 of 10 patients with available MRIs showed a marked reduction of edema at first follow-up. Discontinuation of Dexamethasone was possible in 6 patients and a significant dose reduction could be achieved in all other patients. One patient developed pulmonary artery embolism 2 months after bevacizumab administration. The median time to treatment failure of any cause was 3 months.ConclusionsSingle-shot bevacizumab therefore has meaningful activity in cerebral radiation injury, but durable control is rarely achieved. In patients where a complete protocol of four infusions with bevacizumab is not feasible due to medical contraindications or lack of reimbursement, single-shot bevacizumab treatment may be considered.

【 授权许可】

CC BY