Low-Dose Bevacizumab Is Effective in Radiation-Induced Necrosis
The second case is a 48-year-old woman who was initially diagnosed with cutaneous melanoma on the right deltoid region. Nine years later, she presented with subcutaneous and bone metastasis. She was treated with ipilimumab and achieved a complete systemic response. However, 3 weeks after her fourth dose of ipilimumab, a routine MRI of the brain showed a single brain metastasis. She underwent SRS followed by whole-brain irradiation. Three months later, the patient presented with partial seizures (facial tremor). A brain MRI with perfusion and spectroscopy showed severe vasogenic edema consistent with radionecrosis. A surgical approach to this lesion would have resulted in partial facial paresis; therefore, the patient refused the procedure.\nThe patient was started on dexamethasone, 4 mg p.o. t.i.d. for 3 months, with a partial seizure control, but during steroid taper, her seizures resumed. She was then started on bevacizumab, 5 mg/kg, with rapid clinical improvement. Due to her financial constraints, bevacizumab was scheduled every 6 weeks. Nonetheless, her symptoms disappeared and a repeat MRI of the brain showed an important reduction of the vasogenic edema (as shown in the FLAIR sequence of her MRI) (fig. ). After only 4 weeks since starting bevacizumab, dexamethasone was discontinued.