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Treatment of Cerebral Radiation Necrosis With Bevacizumab

The Cleveland Clinic Experience

Sadraei, Neda H. MD*; Dahiya, Saurabh MD*; Chao, Samuel T. MD*,†; Murphy, Erin S. MD*,†; Osei-Boateng, Kwabena MD; Xie, Hao PhD*; Suh, John H. MD; Peereboom, David M. MD*,‡; Stevens, Glen H. J. DO, PhD*; Ahluwalia, Manmeet S. MD, FACP*,‡

American Journal of Clinical Oncology: June 2015 - Volume 38 - Issue 3 - p 304–310
doi: 10.1097/COC.0b013e31829c3139
Original Articles: Central Nervous System

Background: Cerebral radiation necrosis (RN) is a devastating complication of radiation therapy for brain tumors. Recent studies have explored the role of bevacizumab, a humanized monoclonal antibody directed against vascular endothelial growth factor in the treatment of RN of the brain. We report 24 patients with cerebral RN who were treated with bevacizumab.

Materials and Methods: Twenty-four patients diagnosed with cerebral RN and treated with different schedules of bevacizumab between July 2007 and June 2012, were identified from the Cleveland Clinic Brain Tumor and Neuro-Oncology Center’s database. Pretreatment and posttreatment magnetic resonance imaging (MRI) studies were compared to evaluate bevacizumab efficacy.

Results: Posttreatment MRI demonstrated a radiographic improvement in 23 of 24 patients on the postcontrast T1-weighted MRI and fluid-attenuated inversion-recovery sequences. Using the McDonald criteria, the average change in the T1-weighted postcontrast MRI was a decrease of 48.1%, and the average change in the fluid-attenuated inversion-recovery images was a decrease of 53.7%. There was a mean daily dose reduction of 9.4 mg of dexamethasone after initiation of bevacizumab in patients who were on steroids at the start of bevaciuzmab therapy for RN. Treatment with bevacizumab was well tolerated with only 1 grade 3 adverse event.

Conclusions: The current study demonstrates that bevacizumab treatment results in excellent clinical and radiologic response in patients with RN caused by common forms of radiation therapy. The safety profile of bevacizumab use in RN is acceptable. In the current study, we found no difference between different schedules of bevacizumab in treatment outcomes.

*Cleveland Clinic Lerner College of Medicine, Rose Ella Burkhardt Brain Tumor Neuro-Oncology Center, Neurological Institute

Radiation Oncology

Solid Tumor Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH

N.H.S. and S.D. contributed equally.

M.S.A. has served on advisory board for Roche/Genentech. The remaining authors declare no conflicts of interest.

Reprints: Manmeet S. Ahluwalia, MD, FACP, Cleveland Clinic Lerner College of Medicine, Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, S73, Cleveland, OH 44195. E-mail:

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