Bevacizumab as therapy for radiation necrosis in four children with pontine gliomas.
OBJECTIVE
Diffuse pontine gliomas are a pediatric brain tumor that is fatal in nearly all patients. Given the poor prognosis for patients with this tumor, their quality of life is very important. Radiation therapy provides some palliation, but can result in radiation necrosis and associated neurologic decline. The typical treatment for this necrosis is steroid therapy. Although the steroids are effective, they have numerous side effects that can often significantly compromise quality of life. Bevacizumab, an antibody against vascular endothelial growth factor, has been suggested as a treatment for radiation necrosis. We report on our initial experience with bevacizumab therapy for radiation necrosis in pediatric pontine gliomas.


METHODS
Four children with pontine gliomas treated at the Children's Hospital in Denver and the University of Colorado Denver developed evidence of radiation necrosis both clinically and on imaging. Those 4 children then received bevacizumab as a treatment for the radiation necrosis. We reviewed the clinical outcome and imaging findings.


RESULTS
After bevacizumab therapy, 3 children had significant clinical improvement and were able to discontinue steroid use. One child continued to decline, and, in retrospect, had disease progression, not radiation necrosis. In all cases, bevacizumab was well tolerated.


CONCLUSIONS
In children with pontine gliomas, bevacizumab may provide both therapeutic benefit and diagnostic information. More formal evaluation of bevacizumab in these children is needed.
University of Colorado Denver, Department of Radiation Oncology, Aurora, CO 80045, USA. arthur.liu@ucdenver.edu
Arthur K
AK
Liu
Margaret E
ME
Macy
Nicholas K
NK
Foreman
D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D001921:Brain / Q000473:pathology / Q000528:radiation effects*; D001932:Brain Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D002648:Child; D003907:Dexamethasone / Q000031:analogs & derivatives / Q000627:therapeutic use; D017809:Fatal Outcome; D005260:Female; D005910:Glioma / Q000532:radiotherapy* / Q000601:surgery; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009336:Necrosis / Q000188:drug therapy / Q000473:pathology; D011149:Pons; D011788:Quality of Life; D011832:Radiation Injuries / Q000188:drug therapy* / Q000473:pathology; D016634:Radiosurgery / Q000009:adverse effects; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D005938:Glucocorticoids; D042461:Vascular Endothelial Growth Factor A; C004180:dexamethasone 21-phosphate; D000068258:Bevacizumab; D003907:Dexamethasone