Indication of Bevacizumab for Cerebral Radiation Necrosis

Background: The effect of bevacizumab (BVZ) for Cerebral Radiation Necrosis (CRN) was clear. However, the indications of BVZ had no reports. Objective: The aim of the paper was to investigate the indications of BVZ for CRN. Methods: Fourteen CRN patients (confirmed by imaging diagnosis) who underwent BVZ treatment between June 2011 and December 2014 were analyzed. BVZ was administered (5mg/kg body weight) once every three to four weeks for at least three cycles. Contrast-enhanced T1 MRI signal intensity changes were measured after BVZ treatment, to evaluate the clinical efficacy of BVZ and the recurrence and progression of CRN. Three patients who were followed for a longer duration were described in detail. The main observations included the indications and (the) use of BVZ for CRN. Results: Most patients undergoing BVZ treatment for CRN exhibited recurrence. One of the three patients described in detail was asymptomatic; CRN was reduced but then progressed, and a second course of BVZ failed. The other two patients showed obvious symptoms of primary CRN; CRN was significantly reduced, but then progressed with mild symptoms. A second short course of BVZ showed poor efficacy in one patient who demonstrated long-term stability after BVZ withdrawal. Second long course of BVZ resulted in further aggravation of CRN in the other patient, and a re-examination revealed spontaneous remission of CRN. Conclusion: Symptoms are an indication of BVZ treatment for primary CRN.