Skip to main content

Advertisement

SpringerLink
Log in

Bevacizumab treatment in malignant meningioma with additional radiation necrosis

An MRI diffusion and perfusion case study

Bevacizumab-Behandlung bei malignem Meningeom mit zusätzlicher Radionekrose

Eine MR-Diffusions- und Perfusionsfallstudie

  • Case study
  • Published:
Strahlentherapie und Onkologie Aims and scope Submit manuscript

Abstract

Background and purpose

Recently two retrospective cohort studies report efficacy of bevacizumab in patients with recurrent atypical and anaplastic meningioma. Another successful therapeutic option of bevacizumab seems to be treatment of cerebral radiation necrosis. However, the antiangiogenic effects in MRI diffusion and perfusion in meningiomas have not been previously described in detail. The objective of this research was to evaluate the clinical and MR imaging effects of bevacizumab in a malignant meningioma patient harboring additional cerebral radiation necrosis.

Case presentation

We report the case of an 80-year-old woman who underwent bevacizumab therapy (5 mg/kg every 2 weeks for 2 months) for treatment of a symptomatic radiation necrosis in malignant meningiomatosis of World Health Organization (WHO) grade III. The patient was closely monitored with MRI including diffusion and perfusion studies. Upon bevacizumab therapy, the clinical situation was well stabilized over a period of 4 months until the patient unfortunately died due to pneumonia/septicemia probably unrelated to bevacizumab therapy. Consecutive MRI demonstrated 4 important aspects: (1) considerable decrease of the contrast medium (CM)-enhanced radiation necrosis, (2) mixed response with respect to the meningiomatosis with stable and predominantly growing tumor lesions, (3) a new diffusion-weighted imaging (DWI) lesion in a CM-enhanced tumor as described in gliomas, which we did not interpret as a response to bevacizumab therapy, and (4) new thrombembolic infarcts, which are a known side-effect of bevacizumab treatment.

Conclusion

Bevacizumab is effective in the treatment of radiation necrosis. We could not confirm the potential antitumor effect of bevacizumab in this patient. However, we could describe several new radiographic effects of bevacizumab therapy in malignant meningioma.

Zusammenfassung

Hintergrund

In zwei aktuellen retrospektiven Kohortenstudien konnte eine Wirksamkeit von Bevacizumab bei Patienten mit rezidivierenden atypischen und anaplastischen Meningeomen gezeigt werden. Eine weitere erfolgreiche therapeutische Option von Bevacizumab scheint die Behandlung der Radionekrose zu sein. Die Effekte einer solchen antiangiogenen Therapie auf die MR-Diffusion und -Perfusion sind bisher bei Meningeomen noch nicht im Detail beschrieben worden. Unser Ziel war es, klinische und MR-Effekte unter Bevacizumab-Therapie bei einer Patientin mit malignem Meningeom und zusätzlicher Radionekrose nach wiederholter Bestrahlung zu beschreiben.

Falldarstellung

Wir berichten über eine 80-jährige Frau, die Bevacizumab (5 mg/kg alle 2 Wochen für 2 Monate) zur Behandlung einer symptomatischen Radionekrose nach wiederholter Bestrahlung bei Vorliegen einer malignen Meningeomatose vom WHO-Grad III erhielt. Die Patientin wurde engmaschig magnetresonanztomographisch einschließlich Diffusions- und Perfusionsstudien kontrolliert. Unter Bevacizumab wurde die klinische Situation über einen Zeitraum von 4 Monaten zunächst gut stabilisiert, bis die Patientin leider im Rahmen einer Sepsis nach Pneumonie – wahrscheinlich unabhängig von der Bevacizumab-Therapie – verstarb. Die MRT-Untersuchungen zeigten folgende 4 wichtige Aspekte: (1) erheblicher Rückgang der Kontrastmittel-(KM-)aufnehmenden Radionekrose, (2) gemischte Reaktion in Bezug auf die Meningeomatose mit stabilen, aber überwiegend progredienten Tumorläsionen, (3) Auftreten einer neuen diffusionsgestörten Läsion in einem KM-aufnehmenden Tumorknoten, wie es auch in Gliomen unter Bevacizumab beschrieben worden ist, die wir hier aber nicht als Reaktion auf die Bevacizumab-Therapie interpretieren, und (4) neue thrombembolische Infarkte, die als Nebenwirkung einer Bevacizumab-Therapie bekannt sind.

Schlussfolgerung

Bevacizumab ist bei der Behandlung der Strahlennekrose gut wirksam. Wir konnten in unserem Fall einer malignen Meningeomatose aber nicht die potentielle antitumoröse Wirkung von Bevacizumab bestätigen. Allerdings konnten wir mehrere neue MRT-Effekte unter Bevacizumab-Therapie bei einem malignen Meningeom beschreiben.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Abbreviations

VEGF:

vascular endothelial growth factor

MRI:

magnetic resonance imaging

CM:

contrast medium

DWI:

diffusion weighted imaging

ADC:

apparent diffusion coefficient

Gy:

Gray

RANO:

response assessment in neuro-oncology

WHO:

World Health Organization

References

  1. Vredenburgh JJ, Desjardins A, Herndon JE 2nd et al (2007) Bevacizumab plus irinotecan in recurrent glioblastoma multiforme. J Clin Oncol 25:4722–4729

    Article  CAS  PubMed  Google Scholar 

  2. Matuschek C, Bolke E, Nawatny J et al (2011) Bevacizumab as a treatment option for radiation-induced cerebral necrosis. Strahlenther Onkol 187:135–139

    Article  PubMed  Google Scholar 

  3. Sanborn MR, Danish SF, Rosenfeld MR et al (2011) Treatment of steroid refractory, Gamma Knife related radiation necrosis with bevacizumab: case report and review of the literature. Clin Neurol Neurosurg 113:798–802

    Article  PubMed  Google Scholar 

  4. Modha A, Gutin PH (2005) Diagnosis and treatment of atypical and anaplastic meningiomas: a review. Neurosurgery 57(3):538–550 (discussion 550)

    Article  PubMed  Google Scholar 

  5. Lamszus K, Lengler U, Schmidt NO et al (2000) Vascular endothelial growth factor, hepatocyte growth factor/scatter factor, basic fibroblast growth factor, and placenta growth factor in human meningiomas and their relation to angiogenesis and malignancy. Neurosurgery 46(4):938–947 (discussion 947–948)

    CAS  PubMed  Google Scholar 

  6. Puchner MJ, Hans VH, Harati A et al (2010) Bevacizumab-induced regression of anaplastic meningioma. Ann Oncol 21(12):2445–2446

    Article  CAS  PubMed  Google Scholar 

  7. Lou E, Sumrall AL, Turner S et al (2012) Bevacizumab therapy for adults with recurrent/progressive meningioma: a retrospective series. J Neurooncol 109(1):63–70

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Nayak L, Iwamoto FM, Rudnick JD et al (2012) Atypical and anaplastic meningiomas treated with bevacizumab. J Neurooncol 109(1):187–193

    Article  CAS  PubMed  Google Scholar 

  9. Wen PY, Macdonald DR, Reardon DA et al (2010) Updated response assessment criteria for high-grade gliomas: response assessment in neuro-oncology working group. J Clin Oncol 28(11):1963–1972

    Article  PubMed  Google Scholar 

  10. Leitzen C, Schild HH, Bungart B et al (2010) Prediction of clinical course of glioblastomas by MRI during radiotherapy. Strahlenther Onkol 186(12):681–686

    Article  PubMed  Google Scholar 

  11. Levin VA, Bidaut L, Hou P et al (2011) Randomized double-blind placebo-controlled trial of bevacizumab therapy for radiation necrosis of the central nervous system. Int J Radiat Oncol Biol Phys 79(5):1487–1495

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Jain R, Scarpace LM, Ellika S et al (2010) Imaging response criteria for recurrent gliomas treated with bevacizumab: role of diffusion weighted imaging as an imaging biomarker. J Neurooncol 96(3):423–431

    Article  CAS  PubMed  Google Scholar 

  13. Jain RK (2005) Normalization of tumor vasculature: an emerging concept in antiangiogenic therapy. Science 307(5706):58–62

    Article  CAS  PubMed  Google Scholar 

  14. Rieger J, Bahr O, Muller K et al (2010) Bevacizumab-induced diffusion-restricted lesions in malignant glioma patients. J Neurooncol 99(1):49–56

    Article  CAS  PubMed  Google Scholar 

  15. Gupta A, Young RJ, Karimi S et al (2011) Isolated diffusion restriction precedes the development of enhancing tumor in a subset of patients with glioblastoma. AJNR Am J Neuroradiol 32(7):1301–1306

    Article  CAS  PubMed  Google Scholar 

  16. Paulson ES, Schmainda KM (2008) Comparison of dynamic susceptibility-weighted contrast-enhanced MR methods: recommendations for measuring relative cerebral blood volume in brain tumors. Radiology 249(2):601–613

    Article  PubMed Central  PubMed  Google Scholar 

  17. Fietkau R (2012) Simultane Radiochemotherapie zur Behandlung solider Tumoren. Strahlenther Onkol 188(3 Suppl):263–271

    Article  PubMed  Google Scholar 

  18. Nivazi M, Söhn M, Schwarz SB et al (2012) Radiation treatment parameters for re-irradiation of malignant glioma. Strahlenther Onkol 188(4):328–336

    Article  Google Scholar 

  19. Strenger V, Lackner H, Mayer R et al (2013) Incidence and clinical course of radionecrosis in children with brain tumors. Strahlenther Onkol 189(9):759–764

    Article  CAS  PubMed  Google Scholar 

Download references

Compliance with ethical guidelines

Conflict of interest. J. Boström, M. Seifert, S. Greschus, N. Schäfer, M. Glas, G. Lammering, and U. Herrlinger state that there are no conflicts of interest.

The accompanying manuscript does not include studies on humans or animals.

Author information

Authors and Affiliations

  1. Department of Radiology, University of Bonn Medical Center, Bonn, Germany

    M. Seifert & S. Greschus

  2. Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Bonn, Germany

    N. Schäfer, M. Glas & U. Herrlinger

  3. Department of Neurosurgery, University of Bonn Medical Center, Sigmund-Freud-Str. 25, 53105, Bonn, Germany

    J.P. Boström M.D.

  4. Department of Radiosurgery and Stereotactic Radiotherapy, MediClin Robert Janker Clinic and MVZ MediClin, Bonn, Germany

    J.P. Boström M.D. & G. Lammering

  5. Stem Cell Pathologies, Institute of Reconstructive Neurobiology, University of Bonn Medical Center, Bonn, Germany

    M. Glas

  6. Clinical Cooperation Unit Neurooncology, MediClin Robert Janker Clinic, Bonn, Germany

    M. Glas & G. Lammering

  7. Department of Radiotherapy and Radiation Oncology, Heinrich-Heine-University of Duesseldorf, Duesseldorf, Germany

    G. Lammering

Authors
  1. J.P. Boström M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Seifert
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Greschus
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. N. Schäfer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Glas
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. G. Lammering
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. U. Herrlinger
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J.P. Boström M.D..

Additional information

Jan Boström and Mirko Seifert contributed equally.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Boström, J., Seifert, M., Greschus, S. et al. Bevacizumab treatment in malignant meningioma with additional radiation necrosis. Strahlenther Onkol 190, 416–421 (2014). https://doi.org/10.1007/s00066-013-0505-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00066-013-0505-0

Keywords

Schlüsselwörter

Search

Navigation