title: Effectiveness of bevacizumab for radiation-induced cerebral necrosis in children.
abstract: BACKGROUND
  Bevacizumab has been reported to effectively reduce cerebral edema caused by radiation therapy. However, only limited data with a short follow-up in tumor patients are available so far.
  
  
  METHODS
  Two children suffering from hemorrhage from arteriovenous malformation (AVM) have been treated with stereotactic radiotherapy and developed radiation-induced cerebral edema with deteriorating neurological status despite maximized steroid therapy. Bevacizumab administration at 5 mg/kg body weight was initiated every 2 weeks.
  
  
  RESULTS
  Bevacizumab treatment rapidly ameliorated the neurological deficits, malignant edema and prevented catastrophic complications. Corticoid therapy could be reduced and discontinued. However, after 18 months, both patients showed identical or worse neurological status than before bevacizumab therapy. AVM radiation therapy had been successful to completely obliterate AVMs.
  
  
  CONCLUSIONS
  In our limited experience, bevacizumab may be an effective and safe option for rescue therapy for malignant cerebral edema on the basis of radiation-induced necrosis especially in patients who experience rapid deterioration despite corticoid therapy and/or intolerable steroid side effects. Despite the fact that functional improvement could not be achieved in long-term outcome patients significantly stabilized and improved during periods of acute deterioration. In order to determine the long-term effectiveness of bevacizumab further investigation in placebo-controlled studies with a higher number of patients are required.
authors.affiliation: Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Preuss
authors.forename: W
authors.initials: W
authors.lastname: Hirsch
authors.forename: K T
authors.initials: KT
authors.lastname: Hoffmann
authors.forename: M K
authors.initials: MK
authors.lastname: Bernhard
authors.forename: M
authors.initials: M
authors.lastname: Siekmeyer
authors.forename: W
authors.initials: W
authors.lastname: Kiess
authors.forename: J
authors.initials: J
authors.lastname: Meixensberger
authors.forename: R E
authors.initials: RE
authors.lastname: Wurm
authors.forename: A
authors.initials: A
authors.lastname: Merkenschlager
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000068258:Bevacizumab; D001929:Brain Edema / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology*; D002648:Child; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000175:diagnosis / Q000532:radiotherapy*; D008297:Male; D009336:Necrosis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D011832:Radiation Injuries / Q000175:diagnosis / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab