Efficacy of short-course bevacizumab for brain tumor radiation necrosis with a volumetric analysis.
Authors
Affiliations (3)
Affiliations (3)
- Department of Neurosurgery, Chonnam National University Medical School and Hwasun Hospital, Gwangju, Republic of Korea.
- Department of Medical Science, Graduate School of Biomedical Sciences, Chonnam National University Medical School, Hwasun, Republic of Korea.
- Department of Neurosurgery, Chonnam National University Medical School and Hwasun Hospital, Gwangju, Republic of Korea. Electronic address: [email protected].
Abstract
Radiation necrosis (RN) is a challenging complication of cranial irradiation, often requiring corticosteroids for management. This study evaluates the clinical and radiologic efficacy of a short-course bevacizumab (BEV) regimen for brain tumor RN, with a volumetric assessment. We retrospectively analyzed 11 patients with MRI-confirmed RN who received two or three cycles of BEV (7.5 mg/kg every 3 weeks). Volume changes of nonenhancing RN, enhancing RN, perilesional edema, and total lesion (RN+edema) were quantified at four timepoints (pre-treatment, start, end, and post-treatment) using artificial intelligence-assisted volumetric analysis (DeepBratumIA). Clinical outcomes were assessed using ECOG performance status and changes in corticosteroid use. Clinical improvement or stabilization was observed in 91% of patients, with steroid use decreasing from 91% at baseline to 36% at treatment completion. Median enhancing RN volume significantly decreased from 5.1 cm<sup>3</sup> to 1.2 cm<sup>3</sup> (p = 0.031), while nonenhancing RN volume showed a nonsignificant change (2.3 cm<sup>3</sup> to 2.0 cm<sup>3</sup>, p = 0.414). Perilesional edema volume markedly declined from 65 cm<sup>3</sup> to 18 cm<sup>3</sup> (p = 0.001), and total lesion volume decreased from 69 cm<sup>3</sup> to 21 cm<sup>3</sup> (p = 0.001). No statistically significant differences were observed between steroid-maintained and steroid-discontinued groups in the magnitude of volume change at any time point. Partial volumetric rebound occurred post-treatment, but most patients maintained clinical benefit. This study suggests the clinical and radiologic efficacy of short-course BEV as a practical steroid-sparing strategy for radiation necrosis management.