Oncotarget

Case Reports:

Resolution of radiation necrosis with bevacizumab following radiation therapy for primary CNS lymphoma

Eugene J. Vaios _, Kristen A. Batich, Anne F. Buckley, Anastasie Dunn-Pirio, Mallika P. Patel, John P. Kirkpatrick, Ranjit Goudar and Katherine B. Peters

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Oncotarget. 2022; 13:576-582. https://doi.org/10.18632/oncotarget.28222

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Abstract

Eugene J. Vaios1, Kristen A. Batich2, Anne F. Buckley3, Anastasie Dunn-Pirio4, Mallika P. Patel5, John P. Kirkpatrick1, Ranjit Goudar6 and Katherine B. Peters7,8

1 Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA

2 Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, NC, USA

3 Department of Pathology, Duke University Medical Center, Durham, NC, USA

4 Department of Neurology, UC San Diego Health, San Diego, CA, USA

5 Department of Pharmacy, Duke University Medical Center, Durham, NC, USA

6 Virginia Oncology Associates, Norfolk, VA, USA

7 Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA

8 Department of Neurology, Duke University Medical Center, Durham, NC, USA

Correspondence to:

Eugene J. Vaios, email: eugene.vaios@duke.edu

Keywords: radiation necrosis; brain tumor; primary CNS lymphoma; stereotactic radiosurgery; bevacizumab

Received: January 03, 2022     Accepted: March 08, 2022     Published: March 29, 2022

Copyright: © 2022 Vaios et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

ABSTRACT

Importance: Radiation necrosis (RN) is a rare but serious adverse effect following treatment with radiation therapy. No standard of care exists for the management of RN, and efforts to prevent and treat RN are limited by a lack of insight into the pathomechanics and molecular drivers of RN. This case series describes the outcomes of treatment with bevacizumab (BV) in two primary CNS lymphoma (PCNSL) patients who developed symptomatic biopsy-proven RN after whole brain radiation (WBRT) with a stereotactic radiosurgery (SRS) boost.

Observations: Patient 1 is a 52 year-old female with PCNSL treated with WBRT followed by an SRS boost. She developed symptomatic biopsy-proven RN, and initial treatment with tocopherol and pentoxifylline was unsuccessful. A 100% clinical and radiographic response was achieved with 4 cycles of BV. Patient 2, a 48 year-old male with PCNSL, presented with seizures and biopsy-proven RN after radiation therapy. Initial empiric treatment with tocopherol and pentoxifylline was unsuccessful. A 100% clinical and radiographic response was achieved with 3 cycles of BV.

Conclusions and Relevance: Monitoring for RN in patients with PCNSL treated with radiation therapy is warranted. BV is an efficacious treatment and a viable alternative to corticosteroids or surgical intervention.


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