title: Bevacizumab in late-onset radiation-induced myelopathy.
abstract: OBJECTIVE
  To investigate the efficacy of bevacizumab for treatment of late radiation-induced myelopathy.
  
  
  METHODS
  We studied all patients diagnosed with radiation-induced myelopathy presenting to 2 neuro-oncology centers between 2008 and 2012. All patients were treated with bevacizumab, after no clinical or radiologic improvement was achieved with conventional (in particular steroid) treatment.
  
  
  RESULTS
  This was a retrospective case study of 4 patients (2 women) with late-onset radiation-induced myelopathy who were each treated with 4 cycles of bevacizumab. The median delay from radiotherapy to myelopathy was 19 months (range 14-22 months). Initial treatment with steroids was unsuccessful in all 4 patients. Bevacizumab was introduced after a median of 4.8 months (range 4-5 months) from the onset of the neurologic symptoms. We observed stabilization of clinical outcome in 3 patients. Radiologic findings improved in all 4 patients.
  
  
  CONCLUSIONS
  The use of bevacizumab resulted in radiologic improvement, but had only a modest effect on clinical outcome.
  
  
  METHODS
  This study provides Class IV evidence that for patients with late radiation-induced myelopathy unresponsive to steroids, bevacizumab improves radiologic but not clinical outcomes.
authors.affiliation: From the Department of Neurology, Mazarin Clinic (D.P., J.Y.D.), and Departments of Neuro-Radiology (D.L.) and Radiotherapy (L.F.), Pitié-Salpêtrière Hospital; UPMC Univ Paris 06 (D.P., J.Y.D.), Sorbonne Universités, UM 75, ICM; Inserm (D.P., J.Y.D.), U 1127, ICM; CNRS (D.P., J.Y.D.), UMR 7225, ICM; Department of Neurology, Hôpital d'Instruction des Armées du Val-de-Grâce (C.T., D.R.), CNRS, UMR 8257 MD4 COGNAC G (D.R.), and Ecole du Val-de-Grâce (C.T., D.R.), Service de Santé des Armées, Paris; and Department of Neuro-oncology (F.D.), Lyon Hospital, France. dimitri.psimaras@psl.aphp.fr.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Psimaras
authors.affiliation: From the Department of Neurology, Mazarin Clinic (D.P., J.Y.D.), and Departments of Neuro-Radiology (D.L.) and Radiotherapy (L.F.), Pitié-Salpêtrière Hospital; UPMC Univ Paris 06 (D.P., J.Y.D.), Sorbonne Universités, UM 75, ICM; Inserm (D.P., J.Y.D.), U 1127, ICM; CNRS (D.P., J.Y.D.), UMR 7225, ICM; Department of Neurology, Hôpital d'Instruction des Armées du Val-de-Grâce (C.T., D.R.), CNRS, UMR 8257 MD4 COGNAC G (D.R.), and Ecole du Val-de-Grâce (C.T., D.R.), Service de Santé des Armées, Paris; and Department of Neuro-oncology (F.D.), Lyon Hospital, France.
authors.forename: Camille
authors.initials: C
authors.lastname: Tafani
authors.affiliation: From the Department of Neurology, Mazarin Clinic (D.P., J.Y.D.), and Departments of Neuro-Radiology (D.L.) and Radiotherapy (L.F.), Pitié-Salpêtrière Hospital; UPMC Univ Paris 06 (D.P., J.Y.D.), Sorbonne Universités, UM 75, ICM; Inserm (D.P., J.Y.D.), U 1127, ICM; CNRS (D.P., J.Y.D.), UMR 7225, ICM; Department of Neurology, Hôpital d'Instruction des Armées du Val-de-Grâce (C.T., D.R.), CNRS, UMR 8257 MD4 COGNAC G (D.R.), and Ecole du Val-de-Grâce (C.T., D.R.), Service de Santé des Armées, Paris; and Department of Neuro-oncology (F.D.), Lyon Hospital, France.
authors.forename: Francois
authors.initials: F
authors.lastname: Ducray
authors.affiliation: From the Department of Neurology, Mazarin Clinic (D.P., J.Y.D.), and Departments of Neuro-Radiology (D.L.) and Radiotherapy (L.F.), Pitié-Salpêtrière Hospital; UPMC Univ Paris 06 (D.P., J.Y.D.), Sorbonne Universités, UM 75, ICM; Inserm (D.P., J.Y.D.), U 1127, ICM; CNRS (D.P., J.Y.D.), UMR 7225, ICM; Department of Neurology, Hôpital d'Instruction des Armées du Val-de-Grâce (C.T., D.R.), CNRS, UMR 8257 MD4 COGNAC G (D.R.), and Ecole du Val-de-Grâce (C.T., D.R.), Service de Santé des Armées, Paris; and Department of Neuro-oncology (F.D.), Lyon Hospital, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Leclercq
authors.affiliation: From the Department of Neurology, Mazarin Clinic (D.P., J.Y.D.), and Departments of Neuro-Radiology (D.L.) and Radiotherapy (L.F.), Pitié-Salpêtrière Hospital; UPMC Univ Paris 06 (D.P., J.Y.D.), Sorbonne Universités, UM 75, ICM; Inserm (D.P., J.Y.D.), U 1127, ICM; CNRS (D.P., J.Y.D.), UMR 7225, ICM; Department of Neurology, Hôpital d'Instruction des Armées du Val-de-Grâce (C.T., D.R.), CNRS, UMR 8257 MD4 COGNAC G (D.R.), and Ecole du Val-de-Grâce (C.T., D.R.), Service de Santé des Armées, Paris; and Department of Neuro-oncology (F.D.), Lyon Hospital, France.
authors.forename: Loic
authors.initials: L
authors.lastname: Feuvret
authors.affiliation: From the Department of Neurology, Mazarin Clinic (D.P., J.Y.D.), and Departments of Neuro-Radiology (D.L.) and Radiotherapy (L.F.), Pitié-Salpêtrière Hospital; UPMC Univ Paris 06 (D.P., J.Y.D.), Sorbonne Universités, UM 75, ICM; Inserm (D.P., J.Y.D.), U 1127, ICM; CNRS (D.P., J.Y.D.), UMR 7225, ICM; Department of Neurology, Hôpital d'Instruction des Armées du Val-de-Grâce (C.T., D.R.), CNRS, UMR 8257 MD4 COGNAC G (D.R.), and Ecole du Val-de-Grâce (C.T., D.R.), Service de Santé des Armées, Paris; and Department of Neuro-oncology (F.D.), Lyon Hospital, France.
authors.forename: Jean Yves
authors.initials: JY
authors.lastname: Delattre
authors.affiliation: From the Department of Neurology, Mazarin Clinic (D.P., J.Y.D.), and Departments of Neuro-Radiology (D.L.) and Radiotherapy (L.F.), Pitié-Salpêtrière Hospital; UPMC Univ Paris 06 (D.P., J.Y.D.), Sorbonne Universités, UM 75, ICM; Inserm (D.P., J.Y.D.), U 1127, ICM; CNRS (D.P., J.Y.D.), UMR 7225, ICM; Department of Neurology, Hôpital d'Instruction des Armées du Val-de-Grâce (C.T., D.R.), CNRS, UMR 8257 MD4 COGNAC G (D.R.), and Ecole du Val-de-Grâce (C.T., D.R.), Service de Santé des Armées, Paris; and Department of Neuro-oncology (F.D.), Lyon Hospital, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Ricard
mesh_terms: D000328:Adult; D000368:Aged; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D000068258:Bevacizumab / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology; D013118:Spinal Cord Diseases / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology
chemical_list: D020533:Angiogenesis Inhibitors; D000068258:Bevacizumab