Exploration of the recurrence in radiation brain necrosis after bevacizumab discontinuation

// Hongqing Zhuang 1 , Xiangkun Yuan 2 , Joe Y. Chang 3 , Yongchun Song 1 , Junjie Wang 4 , Zhiyong Yuan 1 , Xiaoguang Wang 1 and Ping Wang 1 1 Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin, China 2 Department of Radiotherapy, Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine (Cangzhou No. 2 Hospital), Hebei, China 3 Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America 4 Department of Radiotherapy, Peking University 3rd Hospital, Beijing, China Correspondence to: Hongqing Zhuang, email: // Keywords : bevacizumab, brain necrosis, recurrence Received : November 27, 2015 Accepted : February 08, 2016 Published : February 26, 2016 Abstract Objective: The aim of the paper was to investigate the recurrence and its causes of radiation brain necrosis following bevacizumab discontinuation. Methods: This study included 14 patients with radiation brain necrosis (confirmed through imaging) after stereotactic radiotherapy for a primary or metastatic brain tumor and who received bevacizumab treatment from June 2011 through December 2014. The patients received bevacizumab at 5 mg/kg, q3-4w, for at least 3 cycles. The T1 signal intensity from enhanced MRI images was used as the evaluation criteria for the brain necrosis treatment efficacy. Results: brain necrosis improved in 13 of the 14 cases (92.9%). However, during follow-up, 10 of the 13 responsive patients (76.9%) exhibited a recurrence in brain necrosis, and a multiple linear regression analysis shows that brain necrosis recurrence was related to the follow-up time after the initial bevacizumab treatment discontinuation. Conclusion: bevacizumab produced good short-term effects for radiation brain necrosis; however, most of the patients would recurrence after bevacizumab is discontinued. Thus, brain necrosis was irreversible.