scholarly journals Adrenal Insufficiency in Patients with Corticosteroid-Refractory Cerebral Radiation Necrosis Treated with Bevacizumab

2019 ◽  
Vol 8 (10) ◽  
pp. 1608 ◽  
Author(s):  
Voss ◽  
Batarfi ◽  
Steidl ◽  
Wagner ◽  
Forster ◽  
...  
Keyword(s):  
Adrenal Insufficiency ◽  
Steroid Therapy ◽  
Radiation Necrosis ◽  
Standard Of Care ◽  
Serum Cortisol ◽  
Hormone Substitution ◽  
Cerebral Radiation Necrosis ◽  
Bevacizumab Treatment ◽  
Highly Effective ◽  
Endothelial Growth Factor

Cerebral radiation necrosis is a common complication of the radiotherapy of brain tumours that can cause significant mortality. Corticosteroids are the standard of care, but their efficacy is limited and the consequences of long-term steroid therapy are problematic, including the risk of adrenal insufficiency (AI). Off-label treatment with the vascular endothelial growth factor A antibody bevacizumab is highly effective in steroid-resistant radiation necrosis. Both the preservation of neural tissue integrity and the cessation of steroid therapy are key goals of bevacizumab treatment. However, the withdrawal of steroids may be impossible in patients who develop AI. In order to elucidate the frequency of AI in patients with cerebral radiation necrosis after treatment with corticosteroids and bevacizumab, we performed a retrospective study at our institution’s brain tumour centre. We obtained data on the tumour histology, age, duration and maximum dose of dexamethasone, radiologic response to bevacizumab, serum cortisol, and the need for hydrocortisone substitution for AI. We identified 17 patients with cerebral radiation necrosis who had received treatment with bevacizumab and had at least one available cortisol analysis. Fifteen patients (88%) had a radiologic response to bevacizumab. Five of the 17 patients (29%) fulfilled criteria for AI and required hormone substitution. Age, duration of dexamethasone treatment, and time since radiation were not statistically associated with the development of AI. In summary, despite the highly effective treatment of cerebral radiation necrosis with bevacizumab, steroids could yet not be discontinued due to the development of AI in roughly one-third of patients. Vigilance to spot the clinical and laboratory signs of AI and appropriate testing and management are, therefore, mandated.

scholarly journals P14.08 Bevacizumab treatment for the lesion emerging after the radiotherapy for malignant glioma

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii68-iii68
Author(s):  
K Miwa ◽  
T Ito ◽  
K Yokoyama ◽  
J Shinoda
Keyword(s):  
Malignant Glioma ◽  
Tumor Recurrence ◽  
Clinical Course ◽  
Radiation Necrosis ◽  
Neurological Dysfunction ◽  
Vascular Endothelial ◽  
Recurrent Malignant Glioma ◽  
Positron Emission ◽  
Bevacizumab Treatment ◽  
Endothelial Growth Factor

Abstract BACKGROUND Because blocking vascular endothelial growth factor from reaching leaky capillaries is a logical strategy for the treatment, we reasoned that bevacizumab might be an effective treatment on recurrent malignant glioma and radiation necrosis (RN). In this study, the authors examined to differentiate RN from recurrent malignant glioma, and evaluated the results of bevacizumab treatment in each diagnosis. MATERIAL AND METHODS Four patients of malignant glioma (2 glioblastomas and 2 anaplastic astrocytomas), which demonstrated symptomatic lesion after radiotherapy, were involved in this study. All four patients were treated with bevacizumab on a 10 mg/kg biweekly (one cycle), for a total dose of 30 mg/kg (3 cycles) or furthermore. RN was differentiated from local recurrence in all four patients on the basis of 11C-methionine positron emission tomography and/or clinical course. Clinical evaluation and MRI studies were obtained after bevacizumab treatment in all cases repeatedly as possible. RESULTS Two patients were diagnosed as RN, and another two patients as tumor recurrence. Of the two patients with RN, neurological dysfunction was distinctly alleviated after bevacizumab treatment. Other two patients with tumor recurrence demonstrated no remarkable improvement in neurological dysfunction after bevacizumab treatment. Of all the two patients with RN, post-treatment MRI performed after the bevacizumab therapy showed a significant reduction of the massive lesion. CONCLUSION We concluded that bevacizumab could control the symptomatic massive lesion occurring after radiotherapy, and it might be more effective with the patients of RN, than with those of recurrent tumor.

scholarly journals Reversal of cerebral radiation necrosis with bevacizumab treatment in 17 Chinese patients

2012 ◽  
Vol 17 (1) ◽  
pp. 25 ◽  
Author(s):  
Yang Wang ◽  
Li Pan ◽  
Xiaofang Sheng ◽  
Yin Mao ◽  
Yu Yao ◽  
...  
Keyword(s):  
Radiation Necrosis ◽  
Chinese Patients ◽  
Cerebral Radiation Necrosis ◽  
Bevacizumab Treatment

Iatrogenic cerebral radiation necrosis

2021 ◽  
pp. practneurol-2020-002904
Author(s):  
Carolina Maria Helena Hilton ◽  
Lena Specht ◽  
Eva Loebner Lund ◽  
Pernille Christina Martens ◽  
Grethe Schmidt ◽  
...  
Keyword(s):  
Monoclonal Antibody ◽  
Vascular Endothelial Growth Factor ◽  
Growth Factor ◽  
Arteriovenous Malformation ◽  
Radiation Necrosis ◽  
Vascular Endothelial ◽  
Cerebral Radiation Necrosis ◽  
High Doses ◽  
Endothelial Growth Factor ◽  
The Brain

Cerebral radiation necrosis is the most serious late reaction to high doses of ionising radiation to the brain, and its treatment is generally unsatisfactory. We present a patient who developed cerebral radiation necrosis after protracted fluoroscopy during repeated embolisations of an extracranial arteriovenous malformation. Treatment with bevacizumab (a humanised murine monoclonal antibody against vascular endothelial growth factor) was followed by neurological and radiological improvements.

scholarly journals NCMP-01. THE ROLE OF VASCULAR ENDOTHELIAL GROWTH FACTOR RECEPTOR INHIBITORS IN PREVENTING CEREBRAL RADIATION NECROSIS: A RETROSPECTIVE COHORT STUDY

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii123-ii123
Author(s):  
Iyad Alnahhas ◽  
Appaji Rayi ◽  
Joshua Palmer ◽  
Raju Raval ◽  
Edmund Folefac ◽  
...  
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Growth Factor ◽  
Brain Metastases ◽  
Cumulative Incidence ◽  
Radiation Necrosis ◽  
Vegf Receptor ◽  
Vascular Endothelial ◽  
Cerebral Radiation Necrosis ◽  
Significant Difference ◽  
Endothelial Growth Factor

Abstract INTRODUCTION Radiation necrosis (RN) is a potential complication after radiation therapy to primary brain tumors and brain metastases. The pathophysiology of RN is not well understood but it is hypothesized that vascular endothelial growth factor (VEGF) plays an important role. Bevacizumab, a monoclonal antibody against VEGF-A, is often successful in the management of RN. The objective of this study is to assess whether VEGF receptor (VEGFR) inhibitors, a group of oral tyrosine kinase inhibitors (TKIs), can prevent or reverse cerebral radiation necrosis METHODS We retrospectively studied a cohort of 102 patients with renal cell carcinoma (RCC) and brain metastases seen at The Ohio State University James Cancer Center between 01/01/2011 and 04/30/2019. We identified those who developed RN and analyzed the temporal relationship between the use of VEGFR TKIs and the development of RN. RESULTS The cumulative incidence of RN in our cohort is 13.7% after radiation treatments that included LINAC-based stereotactic radiosurgery, fractionated stereotactic radiotherapy, or Gamma Knife radiosurgery. There was no statistically significant difference in the cumulative incidence of RN between patients taking TKIs and patients who were off TKIs (9.9% and 11.5% respectively, p= 0.741). The median time to development of RN was only numerically shorter in patients taking TKIs (151 versus 315 days, p=0.315). One patient developed RN after stopping cabozantinib. Three other patients developed RN while on cabozantinib. Two patients developed RN while on pazopanib, and 3 patients developed RN while on sunitinib. One patient was started on axitinib during active RN without significant improvement subsequently. CONCLUSIONS VEGFR TKIs do not consistently prevent or reverse cerebral radiation necrosis and do not seem to have the efficacy that bevacizumab has against RN.

Initial experience with bevacizumab treatment for biopsy confirmed cerebral radiation necrosis

2009 ◽  
Vol 94 (1) ◽  
pp. 63-68 ◽  
Author(s):  
Roy Torcuator ◽  
Richard Zuniga ◽  
Yedathore S. Mohan ◽  
Jack Rock ◽  
Thomas Doyle ◽  
...  
Keyword(s):  
Radiation Necrosis ◽  
Initial Experience ◽  
Cerebral Radiation Necrosis ◽  
Bevacizumab Treatment

Bevacizumab efficacy in treatment of brain radiation necrosis

2019 ◽  
Vol 1 (10) ◽  
pp. 15-21
Author(s):  
O. V. Absalyamova ◽  
G. L. Kobiakov ◽  
S. L. Gutorov ◽  
E. R. Vetlova ◽  
S. V. Zolotova ◽  
...  
Keyword(s):  
Adverse Effect ◽  
Vascular Endothelial Growth Factor ◽  
Arteriovenous Malformations ◽  
Radiation Necrosis ◽  
Critical Role ◽  
Common Adverse Effect ◽  
Vascular Endothelial ◽  
Brain Radiation Necrosis ◽  
Endothelial Growth Factor ◽  
Brain Radiation

Radiation therapy (RT) plays an important role in treatment of primary and metastatic CNS tumors and some non-neopiastic conditions (arteriovenous malformations, trigeminal neuralgia). Radiation necrosis (RN) is a common adverse effect of RT. Until recently steroid therapy was used as a main treatment regimen for RN. Mechanisms of RN development are not clear; however, it was shown that vascular endothelial growth factor (VEGF) plays a critical role in its formation. A number of surveys showed efficacy of bevacizumab as an anti-VEGF agent in treatment of RN. Radiation necrosis pathogenesis, diagnostics and treatment are summarized in this review.

Steroid Therapy in Adrenal Insufficiency

2017 ◽  
Vol 6 (2) ◽  
Author(s):  
Lahiry  Sandeep ◽  
Ayan Mukherjee ◽  
Shouvik Choudhury ◽  
Dwaipayan Sarathi Chakraborty ◽  
Sinha Rajasree
Keyword(s):  
Adrenal Insufficiency ◽  
Steroid Therapy

scholarly journals Proof-of-concept single-arm trial of bevacizumab therapy for brain arteriovenous malformation

2021 ◽  
Vol 3 (1) ◽  
pp. e000114
Author(s):  
Rachel Muster ◽  
Nerissa Ko ◽  
Wade Smith ◽  
Hua Su ◽  
Melissa A Dickey ◽  
...  
Keyword(s):  
Pilot Study ◽  
Primary Outcome ◽  
Drug Effects ◽  
Primary Outcome Measure ◽  
Vascular Endothelial ◽  
Bevacizumab Treatment ◽  
Registration Number ◽  
Endothelial Growth Factor ◽  
Dose Dependent ◽  
Radiographic Changes

Brain arteriovenous malformations (bAVMs) are relatively rare, although their potential for secondary intracranial haemorrhage (ICH) makes their diagnosis and management essential to the community. Currently, invasive therapies (surgical resection, stereotactic radiosurgery and endovascular embolisation) are the only interventions that offer a reduction in ICH risk. There is no designated medical therapy for bAVM, although there is growing animal and human evidence supporting a role for bevacizumab to reduce the size of AVMs. In this single-arm pilot study, two patients with large bAVMs (deemed unresectable by an interdisciplinary team) received bevacizumab 5 mg/kg every 2 weeks for 12 weeks. Due to limitations of external funding, the intended sample size of 10 participants was not reached. Primary outcome measure was change in bAVM volume from baseline at 26 and 52 weeks. No change in bAVM volume was observed 26 or 52 weeks after bevacizumab treatment. No clinically important adverse events were observed during the 52-week study period. There were no observed instances of ICH. Sera vascular endothelial growth factor levels were reduced at 26 weeks and returned to baseline at 52 weeks. This pilot study is the first to test bevacizumab for patients with bAVMs. Bevacizumab therapy was well tolerated in both subjects. No radiographic changes were observed over the 52-week study period. Subsequent larger clinical trials are in order to assess for dose-dependent efficacy and rarer adverse drug effects.Trial registration number: NCT02314377.

Cerebral Radiation Necrosis: Incidence, Pathogenesis, Diagnostic Challenges, and Future Opportunities

2019 ◽  
Vol 21 (8) ◽  
Author(s):  
Faisal S. Ali ◽  
Octavio Arevalo ◽  
Soheil Zorofchian ◽  
Anthony Patrizz ◽  
Roy Riascos ◽  
...  
Keyword(s):  
Radiation Necrosis ◽  
Cerebral Radiation Necrosis
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