Journal of Neuro-Oncology

, Volume 117, Issue 2, pp 321–327 | Cite as

An analysis of radiation necrosis of the central nervous system treated with bevacizumab

  • Karen Tye
  • Herbert H. Engelhard
  • Konstantin V. Slavin
  • M. Kelly Nicholas
  • Steven J. Chmura
  • Young Kwok
  • Dominic S. Ho
  • Ralph R. Weichselbaum
  • Matthew KoshyEmail author
Clinical Study


Radiation necrosis is a devastating complication following radiation to the central nervous system. The purpose of this study was to perform a comprehensive analysis of cases in the literature using bevacizumab, a monoclonal antibody against vascular endothelial growth factor, as treatment for radiation necrosis. A MEDLINE/PubMed search of articles about the use of bevacizumab for radionecrosis treatment yielded 16 studies published between 2007 and 2012. Data was summarized according to patient characteristics, treatment received and outcomes measured. A total of 71 unique cases were identified that met the inclusion criteria. The median age at the time of treatment with bevacizumab was 47 years. The most common tumors treated were glioblastoma (31 %), anaplastic glioma (14 %), and metastatic brain tumors (15 %). The median time from ending radiotherapy to starting treatment with bevacizumab was 11 months and the median follow up time after bevacizumab treatment was 8 months. The median number of cycles of bevacizumab was administered was 4, and the median dosage of bevacizumab was 7.5 mg/kg. The median time elapsed between cycles of bevacizumab was 2 weeks. Overall, pre and post treatment imaging revealed a median decrease in T1 contrast enhancement of 63 %, and a 59 % median decrease in T2/FLAIR signal abnormality. Treatment with bevacizumab resulted in a significant radiographic response for patients with radionecrosis. The median dosage of bevacizumab of 7.5 mg/kg for four cycles every 2 weeks should be considered as a treatment option in this patient population.


Bevacizumab Radiation necrosis Radiation Brain tumors 


Conflict of interest

The authors’ report that Dr. Kelly Nicholas is a consultant for Genentech.


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Karen Tye
    • 1
  • Herbert H. Engelhard
    • 2
  • Konstantin V. Slavin
    • 2
  • M. Kelly Nicholas
    • 3
  • Steven J. Chmura
    • 4
  • Young Kwok
    • 5
  • Dominic S. Ho
    • 6
  • Ralph R. Weichselbaum
    • 1
    • 4
  • Matthew Koshy
    • 1
    • 4
    Email author
  1. 1.Department of Radiation OncologyUniversity of Illinois at ChicagoChicagoUSA
  2. 2.Department of NeurosurgeryUniversity of Illinois at ChicagoChicagoUSA
  3. 3.Department of NeurologyThe University of ChicagoChicagoUSA
  4. 4.Department of Radiation and Cellular OncologyThe University of ChicagoChicagoUSA
  5. 5.Department of Radiation OncologyUniversity of MarylandBaltimoreUSA
  6. 6.Department of Medical OncologyUniversity of Illinois at ChicagoChicagoUSA

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