Rescue bevacizumab following symptomatic pseudoprogression of a tectal glioma post-radiotherapy: a case report and review of the literature.

Autor: Nguyen TK; Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, T-Wing 2nd Floor, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada., Perry J; Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada., Sundaram ANE; Division of Neuro-Ophthalmology, Department of Ophthalmology & Vision Services, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada., Detsky J; Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, T-Wing 2nd Floor, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada., Maralani PJ; Division of Neuroradiology, Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada., Calabrese E; Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada., Das S; Division of Neurosurgery, St. Michael'S Hospital, University of Toronto, Toronto, ON, Canada., Sahgal A; Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, T-Wing 2nd Floor, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada. arjun.sahgal@sunnybrook.ca.
Jazyk: angličtina
Zdroj: Journal of neuro-oncology [J Neurooncol] 2019 Jul; Vol. 143 (3), pp. 475-481. Date of Electronic Publication: 2019 May 03.
DOI: 10.1007/s11060-019-03179-y
Abstrakt: Purpose: Radiation-induced pseudoprogression is a subacute clinical entity that is distinct from radiation necrosis and mimics tumor progression. Bevacizumab is a well-described treatment option for radiation necrosis, but its role in pseudoprogression is not clearly defined.
Methods: We report a case of radiation-induced pseudoprogression rescued with bevacizumab in a 20-year-old man with a biopsy-proven low-grade astrocytoma of the tectum. A review of the literature was also conducted specific to bevacizumab as a treatment for symptomatic pseudoprogression after radiotherapy for CNS tumors.
Results: This patient was treated with definitive intensity modulated stereotactic radiotherapy at a total dose of 54 Gy delivered in 30 daily fractions. Six weeks after radiotherapy the patient developed progressive headache, weakness and a documented deterioration in vision, which was accompanied by worsening of radiographic findings. A diagnosis of pseudoprogression was made and after limited benefit from a trial of dexamethasone, four cycles of bevacizumab were administered which resulted in rapid clinical and radiographic improvement.
Conclusions: Our findings support the potential use of bevacizumab as a rescue agent for symptomatic pseudoprogression.
Databáze: MEDLINE
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