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Ultra-Low-Dose Bevacizumab For Cerebral Radiation Necrosis: A Prospective Phase II Clinical Study

Authors Zhuang H, Zhuang H, Shi S, Wang Y

Received 15 July 2019

Accepted for publication 9 September 2019

Published 11 October 2019 Volume 2019:12 Pages 8447—8453


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Prof. Dr. Geoffrey Pietersz

Hongqing Zhuang,1 Hongxia Zhuang,2 Siyu Shi,3 Yuxia Wang1

1Department of Radiation Oncology, Peking University Third Hospital, Beijing, People’s Republic of China; 2Department of Hematology, Weifang People’s Hospital, Weifang, Shandong Province, People’s Republic of China; 3Stanford University School of Medicine, Stanford, CA 94305, USA

Correspondence: Hongqing Zhuang
Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, People’s Republic of China
Tel +86 10 8226 6699

Objective: To investigate the treatment efficacy of ultra-low-dose bevacizumab for cerebral radiation necrosis.
Methods: Patients with cerebral radiation necrosis after stereotactic radiotherapy (SRT) confirmed by imaging were included. Bevacizumab (1 mg/kg, once every three weeks, for at least three continuous treatments) was administered. The primary endpoints included change in cerebral necrosis symptoms, volume of intracranial edema, and changes in MRI signals. The secondary endpoints were adverse reactions of bevacizumab treatment.
Results: In total, 21 patients were included in this study, all of whom received SRT between December 2016 and February 2019, developed cerebral radiation necrosis, and were treated with bevacizumab. Twenty patients were symptomatic from radiation necrosis, and the symptoms were alleviated in 18 patients (90%). Twenty patients had intracranial edema, and the grade of edema index (EI) was improved in 19 patients (95%). The intensity of the intracranial-enhanced MRI signals was significantly reduced in 20 patients (95.24%). The adverse reactions of bevacizumab treatment were mild, and no adverse reactions more severe than grade 2 were found.
Conclusion: The preliminary results showed that ultra-low-dose bevacizumab had high efficacy for treating cerebral radiation necrosis, and could be a valid alternative to the standard-dose bevacizumab.
Clinical registry: Chinese clinical trial registry (ChiCTR-IOD-16009803).

Keywords: bevacizumab, cerebral radiation necrosis, stereotactic radiotherapy, drug dose, edema index

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