Low-Dose Bevacizumab Is Effective in Radiation-Induced Necrosis
The first case is a 51-year-old woman who was diagnosed with metastatic melanoma in the lungs, with an unknown primary tumor. She underwent left inferior lobectomy. Two years later, the patient developed 3 metastatic brain lesions. The largest lesion was surgically resected. After brain surgery, she was treated with whole-brain radiation and fotemustine. Soon after the radiation had been completed, the other 2 lesions were treated with stereotactic radiosurgery (SRS). After 17 months of SRS, the patient presented with severe drowsiness and was unable to ambulate by herself. An MRI of the brain with perfusion and spectroscopy showed radionecrosis. Therapy with bevacizumab, 5 mg/kg every 2 weeks, associated with dexamethasone, 4 mg p.o. q.i.d., was used, and important clinical benefits were noted after 3 days with a complete reversal of her symptoms. During the following 2 months, dexamethasone was discontinued and the patient remained asymptomatic. After 3 months, the dose and the schedule of bevacizumab was modified to 7.5 mg/kg i.v. every 4 weeks. Seventeen months after the first bevacizumab dose was administered, the patient remained neurologically stable and was able to lead a normal life (fig. ).