The Effectiveness of Bevacizumab in Radionecrosis after Radiosurgery of a Single Brain Metastasis

Radionecrosis (RN) of brain tissue is a serious\udlate complication of brain irradiation and\udhistorically has been treated with corticosteroid\udtherapy and alternatively surgical\uddecompression. Recently, bevacizumab has\udbeen suggested for treatment of cerebral radiation\udnecrosis. We present a case of a 73-\udyears-old women affected by a primary nonsmall\udcell lung cancer with a single brain\udmetastasis treated with radiosurgery. Two\udyears after radiosurgery the patient referred\udneurological symptoms and a brain magnetic\udresonance confirmed the presence of RN. The\udpatient refused surgical decompression so\udunderwent at the treatment with bevacizumab\ud7.5 mg/kg/2 weeks for a total of 4 cycles. After\udtwo months of treatment the patient reported\udstrumental and clinical improvement. Ten\udmonths after bevacizumab discontinuation the\udpatient experienced a recurrence of RN with\udevident clinical manifestation and confirmed\udby radiological imaging. A new treatment with\udbevacizumab was not performed due to the\udsystemic progression disease and the worsening\udof clinical status. Despite limited to only\udone clinical case, our study suggests the efficacy\udof bevacizumab to treat RN. Future studies\udare needed to confirm its mechanism and to\udproperly define the optimal scheduling, dosage\udand duration of therapy