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01-08-2014 | Clinical Study

Bevacizumab treatment leads to observable morphological and metabolic changes in brain radiation necrosis

Authors: Shingo Yonezawa, Kazuhiro Miwa, Jun Shinoda, Yuichi Nomura, Yoshitaka Asano, Noriyuki Nakayama, Naoyuki Ohe, Hirohito Yano, Toru Iwama

Published in: Journal of Neuro-Oncology | Issue 1/2014

Abstract

We investigated morphological and metabolic changes of radiation necrosis (RN) of the brain following bevacizumab (BEV) treatment by using neuroimaging. Nine patients with symptomatic RN, who had already been treated with radiation therapy for malignant brain tumors (6 glioblastomas, 1 anaplastic oligodendroglioma, and 2 metastatic brain tumors), were enrolled in this prospective clinical study. RN diagnosis was neuroradiologically determined with Gd-enhanced MRI and 11C-methionine positron emission tomography (MET-PET). RN clinical and radiological changes in MRI, magnetic resonance spectroscopy (MRS) and PET were assessed following BEV therapy. Karnofsky performance status scores improved in seven patients (77.8 %). Both volumes of the Gd-enhanced area and FLAIR-high area from MRI decreased in all patients after BEV therapy and the mean size reduction rates of the lesions were 80.0 and 65.0 %, respectively. MRS, which was performed in three patients, showed a significant reduction in Cho/Cr ratio after BEV therapy. Lesion/normal tissue (L/N) ratios in MET- and 11C-choline positron emission tomography (CHO-PET) decreased in 8 (89 %) and 9 patients (100 %), respectively, and the mean L/N ratio reduction rates were 24.4 and 60.7 %, respectively. BEV-related adverse effects of grade 1 or 2 (anemia, neutropenia and lymphocytopenia) occurred in three patients. These results demonstrated that BEV therapy improved RN both clinically and radiologically. BEV therapeutic mechanisms on RN have been suggested to be related not only to the effect on vascular permeability reduction by repairing the blood–brain barrier, but also to the effect on suppression of tissue biological activity, such as immunoreactions and inflammation.

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Title: Bevacizumab treatment leads to observable morphological and metabolic changes in brain radiation necrosis
Authors: Shingo Yonezawa
Kazuhiro Miwa
Jun Shinoda
Yuichi Nomura
Yoshitaka Asano
Noriyuki Nakayama
Naoyuki Ohe
Hirohito Yano
Toru Iwama
Publication date: 01-08-2014
Publisher: Springer US
Published in: Journal of Neuro-Oncology / Issue 1/2014
Print ISSN: 0167-594X
Electronic ISSN: 1573-7373
DOI: https://doi.org/10.1007/s11060-014-1453-y

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Springer Medicine

Bevacizumab treatment leads to observable morphological and metabolic changes in brain radiation necrosis

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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