Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Effect of Bevacizumab Treatment in Cerebral Radiation Necrosis : Investigation of Response Predictors in a Single-Center Experience

  • Shin Heon Lee (Department of Neurosurgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine) ;
  • Jung Won Choi (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Doo-Sik Kong (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Ho Jun Seol (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Do-Hyun Nam (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jung-Il Lee (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2022.10.24
  • Accepted : 2023.01.12
  • Published : 2023.09.01
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Abstract

Objective : Bevacizumab is a feasible option for treating cerebral radiation necrosis (RN). We investigated the clinical outcome of RN after treatment with bevacizumab and factors related to the initial response and the sustained effect. Methods : Clinical data of 45 patients treated for symptomatic RN between September 2019 and February 2021 were retrospectively collected. Bevacizumab (7.5 mg/kg) was administered at 3-week intervals with a maximum four-cycle schedule. Changes in the lesions magnetic resonance image (MRI) scans were examined for the response evaluation. The subgroup analysis was performed based on the initial response and the long-term maintenance of the effect. Results : Of the 45 patients, 36 patients (80.0%) showed an initial response, and eight patients (17.8%) showed delayed worsening of the corresponding lesion. The non-responders showed a significantly higher incidence of diffusion restriction on MRI than the responders (100.0% vs. 25.0%, p<0.001). The delayed worsening group showed a significantly higher proportion of glioma pathology than the maintenance group (87.5% vs. 28.6%, p=0.005). Cumulative survival rates with sustained effect were significantly higher in the groups with non-glioma pathology (p=0.019) and the absence of diffusion restriction (p<0.001). Pathology of glioma and diffusion restriction in MRI were the independent risk factors for non-response or delayed worsening after initial response. Conclusion : The initial response of RN to bevacizumab was favorable, with improvement in four-fifths of the patients. However, a certain proportion of patients showed non-responsiveness or delayed exacerbations. Bevacizumab may be more effective in treating RN in patients with non-glioma pathology and without diffusion restriction in the MRI.

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References

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