title: The Effectiveness of Bevacizumab in Radionecrosis After Radiosurgery of a Single Brain Metastasis.
abstract: Radionecrosis (RN) of brain tissue is a serious late complication of brain irradiation and historically has been treated with corticos-teroid therapy and alternatively surgical decompression. Recently, bevacizumab has been suggested for treatment of cerebral radiation necrosis. We present a case of a 73-years-old women affected by a primary non-small cell lung cancer with a single brain metastasis treated with radiosurgery. Two years after radiosurgery the patient referred neurological symptoms and a brain magnetic resonance confirmed the presence of RN. The patient refused surgical decompression so underwent at the treatment with bevacizumab 7.5 mg/kg/2 weeks for a total of 4 cycles. After two months of treatment the patient reported strumental and clinical improvement. Ten months after bevacizumab discontinuation the patient experienced a recurrence of RN with evident clinical manifestation and confirmed by radiological imaging. A new treatment with bevacizumab was not performed due to the systemic progression disease and the worsening of clinical status. Despite limited to only one clinical case, our study suggests the efficacy of bevacizumab to treat RN. Future studies are needed to confirm its mechanism and to properly define the optimal scheduling, dosage and duration of therapy.
authors.affiliation: Department of Radiotherapy, University Hospital of Pisa , Italy.
authors.forename: Durim
authors.initials: D
authors.lastname: Delishaj
authors.affiliation: Department of Radiotherapy, University Hospital of Pisa , Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Ursino
authors.affiliation: Department of Radiotherapy, University Hospital of Pisa , Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Pasqualetti
authors.affiliation: Neuroradiology Unit, University Hospital of Pisa , Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Pesaresi
authors.affiliation: Neuroradiology Unit, University Hospital of Pisa , Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Desideri
authors.affiliation: Neuroradiology Unit, University Hospital of Pisa , Italy.
authors.forename: Mirco
authors.initials: M
authors.lastname: Cosottini
authors.affiliation: Department of Radiotherapy, University Hospital of Pisa , Italy.
authors.forename: Concetta
authors.initials: C
authors.lastname: Laliscia
authors.affiliation: Department of Radiotherapy, University Hospital of Pisa , Italy.
authors.forename: Fabiola
authors.initials: F
authors.lastname: Paiar
authors.affiliation: Department of Radiotherapy, University Hospital of Pisa , Italy.
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Fabrini
keywords: Bevacizumab; radionecrosis; stereotactic radiotherapy