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Gecici NN, Gurses ME, Kaye B, Jimenez NLF, Berke C, Gökalp E, Lu VM, Ivan ME, Komotar RJ, Shah AH. Comparative analysis of bevacizumab and LITT for treating radiation necrosis in previously radiated CNS neoplasms: a systematic review and meta-analysis. J Neurooncol 2024; 168:1-11. [PMID: 38619777 PMCID: PMC11093788 DOI: 10.1007/s11060-024-04650-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 03/15/2024] [Indexed: 04/16/2024]
Abstract
PURPOSE Radiation necrosis (RN) is a local inflammatory reaction that arises in response to radiation injury and may cause significant morbidity. This study aims to evaluate and compare the efficacy of bevacizumab and laser interstitial thermal therapy (LITT) in treating RN in patients with previously radiated central nervous system (CNS) neoplasms. METHODS PubMed, Cochrane, Scopus, and EMBASE databases were screened. Studies of patients with radiation necrosis from primary or secondary brain tumors were included. Indirect meta-analysis with random-effect modeling was performed to compare clinical and radiological outcomes. RESULTS Twenty-four studies were included with 210 patients in the bevacizumab group and 337 patients in the LITT group. Bevacizumab demonstrated symptomatic improvement/stability in 87.7% of cases, radiological improvement/stability in 86.2%, and steroid wean-off in 45%. LITT exhibited symptomatic improvement/stability in 71.2%, radiological improvement/stability in 64.7%, and steroid wean-off in 62.4%. Comparative analysis revealed statistically significant differences favoring bevacizumab in symptomatic improvement/stability (p = 0.02), while no significant differences were observed in radiological improvement/stability (p = 0.27) or steroid wean-off (p = 0.90). The rates of adverse reactions were 11.2% for bevacizumab and 14.9% for LITT (p = 0.66), with the majority being grade 2 or lower (72.2% for bevacizumab and 62.5% for LITT). CONCLUSION Both bevacizumab and LITT exhibited favorable clinical and radiological outcomes in managing RN. Bevacizumab was found to be associated with better symptomatic control compared to LITT. Patient-, diagnosis- and lesion-related factors should be considered when choosing the ideal treatment modality for RN to enhance overall patient outcomes.
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Affiliation(s)
- Neslihan Nisa Gecici
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, US
| | - Muhammet Enes Gurses
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, US.
| | - Brandon Kaye
- Dr. Kiran C. Patel College of Allopathic Medicine, Davie, FL, 33326, US
| | | | - Chandler Berke
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, US
| | - Elif Gökalp
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, US
| | - Victor M Lu
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, US
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, US
| | - Ricardo J Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, US
| | - Ashish H Shah
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, US
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Weng Y, Shen J, Zhang L, Fang Z, Xiao F, Zhang C, Fan Z, Huang K, Wang L, Huang B, Wu F, Zhang T, Xu Q. Low-Dosage Bevacizumab Treatment: Effect on Radiation Necrosis After Gamma Knife Radiosurgery for Brain Metastases. Front Surg 2021; 8:720506. [PMID: 34540887 PMCID: PMC8447901 DOI: 10.3389/fsurg.2021.720506] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 07/15/2021] [Indexed: 01/10/2023] Open
Abstract
Cerebral radiation necrosis (RN), a complication of Gamma Knife radiosurgery, is difficult to treat, although bevacizumab seems to be effective. However, clinical data pertaining to bevacizumab treatment for RN are scarce, and its high price is problematic. This study explored the effectiveness of low-dose bevacizumab for RN caused by Gamma Knife. We retrospectively analyzed 22 patients who suffered cerebral RN post-Gamma Knife, and received bevacizumab treatment because of the poor efficacy of glucocorticoids. Low-dose bevacizumab (3 mg/kg) was administered for two cycles at 2-week intervals. T1- and T2-enhanced magnetic resonance imaging (MRI) images were examined for changes in RN status. We also monitored the dose of glucocorticoid, Karnofsky Performance Status (KPS) score, and adverse drug reactions. The mean volume of RN lesions decreased by 45% on T1-weighted images with contrast enhancement, and by 74% on T2-weighted images. All patients discontinued the use of glucocorticoids. According to the KPS scores, all patients showed an improvement in their symptoms and neurological function. No side effects were observed. Low-dosage bevacizumab at a dose of 3 mg/kg every 2 weeks is effective for treating cerebral RN after Gamma knife for brain metastases.
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Affiliation(s)
- Yuxiang Weng
- Department of Neurosurgery, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Jie Shen
- Department of Neurosurgery, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Luyuan Zhang
- Department of Neurosurgery, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Zebin Fang
- Department of Neurosurgery, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Feng Xiao
- Department of Neurosurgery, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Chao Zhang
- Department of Neurosurgery, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Zuoxu Fan
- Department of Neurosurgery, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Kaiyuan Huang
- Department of Neurosurgery, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Liyun Wang
- Department of Neurosurgery, Shengzhou People's Hospital, Shaoxing, China
| | - Bin Huang
- Department of Neurosurgery, Xinchang Hospital of Traditional Chinese Medicine, Shaoxing, China
| | - Fan Wu
- Department of Neurosurgery, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Tiesong Zhang
- Department of Neurosurgery, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Qingsheng Xu
- Department of Neurosurgery, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
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3
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[What is the place of surgery in the management of brain metastases in 2020?]. Cancer Radiother 2020; 24:470-476. [PMID: 32773281 DOI: 10.1016/j.canrad.2020.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 05/22/2020] [Accepted: 05/29/2020] [Indexed: 11/23/2022]
Abstract
Brain metastases are the most common intracranial tumors and are associated with a dismal prognosis. The management of patients with brain metastases has become more important because of the increased incidence of these tumours, the better treatment of the systemic disease and the improvement of surgical techniques. The treatment requires multidisciplinary approaches and become complex because of new emerging systemic therapy and advancements in neurosurgery and radiation oncology. The surgical treatment has an indispensable role to obtain a tissue diagnosis, in relieving intracranial effect mass and improving neurological status by improving induced encephalopathy. An understanding of the role and indications of the surgery in patients with metastatic brain lesions is essential for the effective management of this growing population.
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Baroni LV, Alderete D, Solano-Paez P, Rugilo C, Freytes C, Laughlin S, Fonseca A, Bartels U, Tabori U, Bouffet E, Huang A, Laperriere N, Tsang DS, Sumerauer D, Kyncl M, Ondrová B, Malalasekera VS, Hansford JR, Zápotocký M, Ramaswamy V. Bevacizumab for pediatric radiation necrosis. Neurooncol Pract 2020; 7:409-414. [PMID: 32765892 DOI: 10.1093/nop/npz072] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Radiation necrosis is a frequent complication occurring after the treatment of pediatric brain tumors; however, treatment options remain a challenge. Bevacizumab is an anti-VEGF monoclonal antibody that has been shown in small adult cohorts to confer a benefit, specifically a reduction in steroid usage, but its use in children has not been well described. Methods We describe our experience with bevacizumab use for symptomatic radiation necrosis at 5 institutions including patients treated after both initial irradiation and reirradiation. Results We identified 26 patients treated with bevacizumab for symptomatic radiation necrosis, with a wide range of underlying diagnoses. The average age at diagnosis of radiation necrosis was 10.7 years, with a median time between the last dose of radiation and the presentation of radiation necrosis of 3.8 months (range, 0.6-110 months). Overall, we observed that 13 of 26 patients (50%) had an objective clinical improvement, with only 1 patient suffering from significant hypertension. Radiological improvement, defined as reduced T2/fluid-attenuated inversion recovery signal and mass effect, was observed in 50% of patients; however, this did not completely overlap with clinical response. Both early and late radiation necrosis responded equally well to bevacizumab therapy. Overall, bevacizumab was very well tolerated, permitting a reduction of corticosteroid dose and/or duration in the majority of patients. Conclusions Bevacizumab appears to be effective and well-tolerated in children as treatment for symptomatic radiation necrosis and warrants more robust study in the context of controlled clinical trials.
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Affiliation(s)
- Lorena V Baroni
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada.,Service of Hematology/Oncology, Hospital JP Garrahan, Buenos Aires, Argentina.,Arthur and Sonia Labatt Brain Tumour Research Centre, Programme in Developmental and Stem Cell Biology, Hospital for Sick Children, Toronto, ON, Canada
| | - Daniel Alderete
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada.,Service of Hematology/Oncology, Hospital JP Garrahan, Buenos Aires, Argentina
| | - Palma Solano-Paez
- Service of Pediatric Oncology, Hospital Infantil Virgen del Rocío, Seville, Spain
| | - Carlos Rugilo
- Service of Diagnostic Imaging, Hospital JP Garrahan, Buenos Aires, Argentina
| | - Candela Freytes
- Service of Hematology/Oncology, Hospital JP Garrahan, Buenos Aires, Argentina
| | - Suzanne Laughlin
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada
| | - Adriana Fonseca
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - Ute Bartels
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - Uri Tabori
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Eric Bouffet
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - Annie Huang
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Normand Laperriere
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Derek S Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - David Sumerauer
- Department of Paediatric Haematology and Oncology, Second Medical School, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Martin Kyncl
- Department of Radiology, University Hospital Motol, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | | | - Jordan R Hansford
- Children's Cancer Centre, Royal Children's Hospital, Melbourne, Australia.,Division of Cancer, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne and Monash University, Melbourne, Australia
| | - Michal Zápotocký
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - Vijay Ramaswamy
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada.,Arthur and Sonia Labatt Brain Tumour Research Centre, Programme in Developmental and Stem Cell Biology, Hospital for Sick Children, Toronto, ON, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
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Scerrati A, Mongardi L, Visani J, Lofrese G, Cavallo MA, Fiorentino A, De Bonis P. The controversial role of Bevacizumab in the treatment of patients with intracranial meningioma: a comprehensive literature review. Expert Rev Anticancer Ther 2020; 20:197-203. [PMID: 32116057 DOI: 10.1080/14737140.2020.1736567] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Meningiomas represent the most common primary intracranial tumors. Today, surgical resection, followed by radiotherapy when indicated, is still the treatment of choice. In recent years, distinct oncogenic pathways have been identified, laying the foundations of new personalized targeted therapies.Areas covered: The aim of this study was to highlight the effects, complications, possible associations with other therapeutic approaches and multi-parametric outcome evaluation of Bevacizumab for the treatment of meningiomas. A literature review according to PRISMA criteria regarding the role of Bevacizumab for the treatment of various WHO grades of meningiomas was performed. 15 relevant papers, including 6 retrospective clinical trial series, 3 prospective trials, and 6 single patient case reports for a total of 134 patients and 211 meningiomas were include.Expert opinion: Because of the lack of strong clinical evidence about improved survival and related toxicity, the use of Bevacizumab for the treatment of meningiomas should be carefully evaluated. Further exploration, ideally with randomized controlled trials, is needed to better define the role of this drug in the treatment of meningiomas.
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Affiliation(s)
- Alba Scerrati
- Neurosurgery, Department of Morphology, Surgery and Experimental Medicine, University Hospital S. Anna, Ferrara, Italy.,Neurosurgery Department, San Bortolo Hospital, Vicenza, Italy
| | - Lorenzo Mongardi
- Neurosurgery, Department of Morphology, Surgery and Experimental Medicine, University Hospital S. Anna, Ferrara, Italy
| | - Jacopo Visani
- Neurosurgery, Department of Morphology, Surgery and Experimental Medicine, University Hospital S. Anna, Ferrara, Italy
| | - Giorgio Lofrese
- Neurosurgery Division, "M. Bufalini" Hospital, Cesena, Italy
| | - Michele Alessandro Cavallo
- Neurosurgery, Department of Morphology, Surgery and Experimental Medicine, University Hospital S. Anna, Ferrara, Italy
| | - Alba Fiorentino
- Radiation Oncology Department, General Regional Hospital "F. Miulli", Acquaviva Delle Fonti, Italy
| | - Pasquale De Bonis
- Neurosurgery, Department of Morphology, Surgery and Experimental Medicine, University Hospital S. Anna, Ferrara, Italy
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6
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Zhuang H, Zhuang H, Shi S, Wang Y. Ultra-Low-Dose Bevacizumab For Cerebral Radiation Necrosis: A Prospective Phase II Clinical Study. Onco Targets Ther 2019; 12:8447-8453. [PMID: 31632089 PMCID: PMC6792824 DOI: 10.2147/ott.s223258] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 09/09/2019] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate the treatment efficacy of ultra-low-dose bevacizumab for cerebral radiation necrosis. Methods Patients with cerebral radiation necrosis after stereotactic radiotherapy (SRT) confirmed by imaging were included. Bevacizumab (1 mg/kg, once every three weeks, for at least three continuous treatments) was administered. The primary endpoints included change in cerebral necrosis symptoms, volume of intracranial edema, and changes in MRI signals. The secondary endpoints were adverse reactions of bevacizumab treatment. Results In total, 21 patients were included in this study, all of whom received SRT between December 2016 and February 2019, developed cerebral radiation necrosis, and were treated with bevacizumab. Twenty patients were symptomatic from radiation necrosis, and the symptoms were alleviated in 18 patients (90%). Twenty patients had intracranial edema, and the grade of edema index (EI) was improved in 19 patients (95%). The intensity of the intracranial-enhanced MRI signals was significantly reduced in 20 patients (95.24%). The adverse reactions of bevacizumab treatment were mild, and no adverse reactions more severe than grade 2 were found. Conclusion The preliminary results showed that ultra-low-dose bevacizumab had high efficacy for treating cerebral radiation necrosis, and could be a valid alternative to the standard-dose bevacizumab. Clinical registry Chinese clinical trial registry (ChiCTR-IOD-16009803).
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Affiliation(s)
- Hongqing Zhuang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, People's Republic of China
| | - Hongxia Zhuang
- Department of Hematology, Weifang People's Hospital, Weifang, Shandong Province, People's Republic of China
| | - Siyu Shi
- Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Yuxia Wang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, People's Republic of China
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Abstract
Magnetic resonance imaging (MRI) is the cornerstone for evaluating patients with brain masses such as primary and metastatic tumors. Important challenges in effectively detecting and diagnosing brain metastases and in accurately characterizing their subsequent response to treatment remain. These difficulties include discriminating metastases from potential mimics such as primary brain tumors and infection, detecting small metastases, and differentiating treatment response from tumor recurrence and progression. Optimal patient management could be benefited by improved and well-validated prognostic and predictive imaging markers, as well as early response markers to identify successful treatment prior to changes in tumor size. To address these fundamental needs, newer MRI techniques including diffusion and perfusion imaging, MR spectroscopy, and positron emission tomography (PET) tracers beyond traditionally used 18-fluorodeoxyglucose are the subject of extensive ongoing investigations, with several promising avenues of added value already identified. These newer techniques provide a wealth of physiologic and metabolic information that may supplement standard MR evaluation, by providing the ability to monitor and characterize cellularity, angiogenesis, perfusion, pH, hypoxia, metabolite concentrations, and other critical features of malignancy. This chapter reviews standard and advanced imaging of brain metastases provided by computed tomography, MRI, and amino acid PET, focusing on potential biomarkers that can serve as problem-solving tools in the clinical management of patients with brain metastases.
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Affiliation(s)
- Whitney B Pope
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, United States.
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Delishaj D, Ursino S, Pasqualetti F, Cristaudo A, Cosottini M, Fabrini MG, Paiar F. Bevacizumab for the Treatment of Radiation-Induced Cerebral Necrosis: A Systematic Review of the Literature. J Clin Med Res 2017; 9:273-280. [PMID: 28270886 PMCID: PMC5330769 DOI: 10.14740/jocmr2936e] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2017] [Indexed: 01/10/2023] Open
Abstract
Radiation necrosis (RN) of brain tissue is a serious late complication of brain irradiation and recently bevacizumab has been suggested as treatment option of RN. There is a lack of data in the literature regarding the effectiveness of bevacizumab for the treatment of RN. The purpose of this review was to perform a comprehensive analysis of all reported cases using bevacizumab for the treatment of brain RN. In September 2016, we performed a comprehensive literature search of the following electronic databases: PubMed, Web of Science, Scopus and Cochrane Library. The research for the review was conducted using a combination of the keywords "radiation necrosis", "radiotherapy" and "bevacizumab" alongside the fields comprising article title, abstract and keywords. Randomized trials, non-randomized trials, prospective studies, retrospective studies and single case reports were included in the review. Our research generated 21 studies and 125 cases where bevacizumab had been used for the treatment of RN. The median follow-up was 8 months and the most frequent bevacizumab dose used was 7.5 mg/kg for 2 weeks with a median of four cycles. Low-dose bevacizumab resulted in effectiveness with improvement in both clinical and radiographic response. The median decrease in T1 contrast enhancement and in T2/FLAIR signal abnormality was 64% and 60%, respectively. A reduction in steroidal therapy was observed in majority of patients treated. Based on the data of our review, bevacizumab appears to be a promising agent for the treatment of brain RN. Future prospective studies are required to evaluate the role of bevacizumab in RN and to define the optimal scheduling, dosage and duration of therapy.
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Affiliation(s)
- Durim Delishaj
- Department of Radiotherapy, University Hospital of Pisa, Italy
| | - Stefano Ursino
- Department of Radiotherapy, University Hospital of Pisa, Italy
| | | | | | | | | | - Fabiola Paiar
- Department of Radiotherapy, University Hospital of Pisa, Italy
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