title: Bevacizumab treatment in malignant meningioma with additional radiation necrosis. An MRI diffusion and perfusion case study.
abstract: OBJECTIVE
  Recently two retrospective cohort studies report efficacy of bevacizumab in patients with recurrent atypical and anaplastic meningioma. Another successful therapeutic option of bevacizumab seems to be treatment of cerebral radiation necrosis. However, the antiangiogenic effects in MRI diffusion and perfusion in meningiomas have not been previously described in detail. The objective of this research was to evaluate the clinical and MR imaging effects of bevacizumab in a malignant meningioma patient harboring additional cerebral radiation necrosis.
  
  
  METHODS
  We report the case of an 80-year-old woman who underwent bevacizumab therapy (5 mg/kg every 2 weeks for 2 months) for treatment of a symptomatic radiation necrosis in malignant meningiomatosis of World Health Organization (WHO) grade III. The patient was closely monitored with MRI including diffusion and perfusion studies. Upon bevacizumab therapy, the clinical situation was well stabilized over a period of 4 months until the patient unfortunately died due to pneumonia/septicemia probably unrelated to bevacizumab therapy. Consecutive MRI demonstrated 4 important aspects: (1) considerable decrease of the contrast medium (CM)-enhanced radiation necrosis, (2) mixed response with respect to the meningiomatosis with stable and predominantly growing tumor lesions, (3) a new diffusion-weighted imaging (DWI) lesion in a CM-enhanced tumor as described in gliomas, which we did not interpret as a response to bevacizumab therapy, and (4) new thrombembolic infarcts, which are a known side-effect of bevacizumab treatment.
  
  
  CONCLUSIONS
  Bevacizumab is effective in the treatment of radiation necrosis. We could not confirm the potential antitumor effect of bevacizumab in this patient. However, we could describe several new radiographic effects of bevacizumab therapy in malignant meningioma.
authors.affiliation: Department of Neurosurgery, University of Bonn Medical Center, Sigmund-Freud-Str. 25, 53105, Bonn, Germany, Jan.Bostroem@ukb.uni-bonn.de.
authors.forename: J P
authors.initials: JP
authors.lastname: Boström
authors.forename: M
authors.initials: M
authors.lastname: Seifert
authors.forename: S
authors.initials: S
authors.lastname: Greschus
authors.forename: N
authors.initials: N
authors.lastname: Schäfer
authors.forename: M
authors.initials: M
authors.lastname: Glas
authors.forename: G
authors.initials: G
authors.lastname: Lammering
authors.forename: U
authors.initials: U
authors.lastname: Herrlinger
mesh_terms: D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000068258:Bevacizumab; D001930:Brain Injuries / Q000188:drug therapy* / Q000473:pathology; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods; D008577:Meningeal Neoplasms / Q000473:pathology / Q000628:therapy*; D008579:Meningioma / Q000473:pathology / Q000628:therapy*; D011832:Radiation Injuries / Q000188:drug therapy* / Q000473:pathology; D020266:Radiotherapy, Conformal / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab