Long-Term Relief of Cerebral Radiation Necrosis Treated with Low-Dose Bevacizumab - a Report of 2 Cases.

BACKGROUND: Radiation necrosis is 1 of the most significant complications of brain tumor irradiation. The standard treatment for patients with radiation necrosis consists of corticosteroids to reduce the amount of cerebral edema and, if required, cyst drainage.

CASE REPORTS: 2 patients with symptomatic radiation necrosis initially unresponsive to steroid treatment were treated with repeated low-dose bevacizumab at 5 mg/kg body weight. Rapid and lasting symptom relief, as well as neuroradiological improvement was seen in both cases. A dramatic rapid magnetic resonance imaging response with decrease in contrast enhancement was found shortly after administering the first dose of bevacizumab. The improvement of perifocal edema was relatively slower than of the reduction of enhancement. Only a slight reduction in size of the involved area could be expected after the first dose of bevacizumab. Further shrinkage was seen after the second and third doses. The individuals reported have been doing well for more than 45 and 22 months, respectively, after the initiation of bevacizumab treatment.

CONCLUSION: Our data add to the literature supporting of the use of bevacizumab as an effective therapeutic agent for radiation necrosis, particularly in cases unresponsive to steroid treatment.