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The role of bevacizumab for treatment-refractory intracranial meningiomas: a single institution's experience and a systematic review of the literature. Acta Neurochir (Wien) 2022; 164:3011-3023. [PMID: 36117185 DOI: 10.1007/s00701-022-05348-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/17/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Meningiomas account for over 30% of all primary brain tumors. While surgery can be curative for these tumors, several factors may lead to a higher likelihood of recurrence. For recurrent meningiomas, bevacizumab may be considered as a therapeutic agent, but literature regarding its efficacy is sparse. Thus, we present a systematic review of the literature and case series of patients from our institution with treatment-refractory meningiomas who received bevacizumab. METHODS Patients at our institution who were diagnosed with recurrent meningioma between January 2000 and September 2020 and received bevacizumab monotherapy were included in this study. Bevacizumab duration and dosages were noted, as well as progression-free survival (PFS) after the first bevacizumab injection. A systematic review of the literature was also performed. RESULTS Twenty-three patients at our institution with a median age of 55 years at initial diagnosis qualified for this study. When bevacizumab was administered, 2 patients had WHO grade I meningiomas, 10 patients had WHO grade II meningiomas, and 11 patients had WHO grade III meningiomas. Median PFS after the first bevacizumab injection was 7 months. Progression-free survival rate at 6 months was 57%. Two patients stopped bevacizumab due to hypertension and aphasia. Systematic review of the literature showed limited ability for bevacizumab to control tumor growth. CONCLUSION Bevacizumab is administered to patients with treatment-refractory meningiomas and, though its effectiveness is limited, outperforms other systemic therapies reported in the literature. Further studies are required to identify a successful patient profile for utilization of bevacizumab.
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Okano A, Miyawaki S, Teranishi Y, Ohara K, Hongo H, Sakai Y, Ishigami D, Nakatomi H, Saito N. Advances in Molecular Biological and Translational Studies in World Health Organization Grades 2 and 3 Meningiomas: A Literature Review. Neurol Med Chir (Tokyo) 2022; 62:347-360. [PMID: 35871574 PMCID: PMC9464479 DOI: 10.2176/jns-nmc.2022-0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/10/2022] [Indexed: 11/29/2022] Open
Abstract
The treatment of World Health Organization (WHO) grades 2 and 3 meningiomas remains difficult and controversial. The pathogenesis of high-grade meningiomas was expected to be elucidated to improve treatment strategies. The molecular biology of meningiomas has been clarified in recent years. High-grade meningiomas have been linked to NF2 mutations and 22q deletion. CDKN2A/B homozygous deletion and TERT promoter mutations are independent prognostic factors for WHO grade 3 meningiomas. In addition to 22q loss, 1p, 14p, and 9q loss have been linked to high-grade meningiomas. Meningiomas enriched in copy number alterations may be biologically invasive. Furthermore, several new comprehensive classifications of meningiomas have been proposed based on these molecular biological features, including DNA methylation status. The new classifications may have implications for treatment strategies for refractory aggressive meningiomas because they provide a more accurate prognosis compared to the conventional WHO classification. Although several systemic therapies, including molecular targeted therapies, may be effective in treating refractory aggressive meningiomas, these drugs are being tested. Systemic drug therapy for meningioma is expected to be developed in the future. Thus, this review aims to discuss the distinct genomic alterations observed in WHO grade 2 and 3 meningiomas, as well as their diagnostic and therapeutic implications and systemic drug therapies for high-grade meningiomas.
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Affiliation(s)
- Atsushi Okano
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo
| | - Satoru Miyawaki
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo
| | - Yu Teranishi
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo
| | - Kenta Ohara
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo
| | - Hiroki Hongo
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo
| | - Yu Sakai
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo
| | - Daiichiro Ishigami
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo
| | - Hirofumi Nakatomi
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo
- Department of Neurosurgery, Kyorin University
| | - Nobuhito Saito
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo
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3
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Patel B, Desai R, Pugazenthi S, Butt OH, Huang J, Kim AH. Identification and Management of Aggressive Meningiomas. Front Oncol 2022; 12:851758. [PMID: 35402234 PMCID: PMC8984123 DOI: 10.3389/fonc.2022.851758] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/23/2022] [Indexed: 12/31/2022] Open
Abstract
Meningiomas are common primary central nervous system tumors derived from the meninges, with management most frequently entailing serial monitoring or a combination of surgery and/or radiation therapy. Although often considered benign lesions, meningiomas can not only be surgically inaccessible but also exhibit aggressive growth and recurrence. In such cases, adjuvant radiation and systemic therapy may be required for tumor control. In this review, we briefly describe the current WHO grading scale for meningioma and provide demonstrative cases of treatment-resistant meningiomas. We also summarize frequently observed molecular abnormalities and their correlation with intracranial location and recurrence rate. We then describe how genetic and epigenetic features might supplement or even replace histopathologic features for improved identification of aggressive lesions. Finally, we describe the role of surgery, radiotherapy, and ongoing systemic therapy as well as precision medicine clinical trials for the treatment of recurrent meningioma.
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Affiliation(s)
- Bhuvic Patel
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Rupen Desai
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Sangami Pugazenthi
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Omar H. Butt
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, United States,The Brain Tumor Center, Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, United States
| | - Jiayi Huang
- The Brain Tumor Center, Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, United States,Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Albert H. Kim
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, United States,The Brain Tumor Center, Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, United States,*Correspondence: Albert H. Kim,
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Graillon T, Tabouret E, Chinot O. Chemotherapy and targeted therapies for meningiomas: what is the evidence? Curr Opin Neurol 2021; 34:857-867. [PMID: 34629433 DOI: 10.1097/wco.0000000000001002] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW Although most meningiomas are slow growing tumors mainly controlled by surgery with or without radiotherapy, aggressive meningiomas that fail these conventional treatments constitute a rare situation, a therapeutic challenge and an unmet need in neuro-oncology. RECENT FINDING Mutational landscape in recurrent high-grade meningiomas includes mainly NF2 mutation or 22q chromosomal deletion, whereas telomerase reverse transcriptase promoter, BAP-1 and CDK2NA mutations were also found in aggressive meningiomas. Pi3K-Akt-mTOR pathway is currently the most relevant intracellular signaling pathway target in meningiomas with preliminary clinical activity observed. Assessment of drug activity with progression free survival rate at 6 months is challenging in regard to meningioma growth rate heterogeneity, so that 3-dimensional growth rate before and during treatment could be considered in the future to selected new active drugs. SUMMARY Despite a low evidence level, some systemic therapies may be considered for patients with recurrent meningioma not amenable to further surgery or radiotherapy. In recurrent high-grade meningioma, everolimus-octreotide combination, bevacizumab, sunitinib and peptide receptor radionuclide therapy exhibit a signal of activity that may justify their clinical use. Despite a lack of clear signal of activity to date, immunotherapy may offer new perspectives in the treatment of these refractory tumors.
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Affiliation(s)
- Thomas Graillon
- Aix Marseille Univ, APHM, INSERM, MMG, UMR1251, La Timone Hospital, neurosurgery department Marseille, France
| | - Emeline Tabouret
- Aix-Marseille Univ, APHM, CNRS, INP, Inst Neurophysiopathol, La Timone Hospital, Neurooncology Department, Marseille, France
| | - Olivier Chinot
- Aix-Marseille Univ, APHM, CNRS, INP, Inst Neurophysiopathol, La Timone Hospital, Neurooncology Department, Marseille, France
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Kim YS, Jang WY, Lee KH, Moon KS, Jung TY, Jung S. Bevacizumab-refractory radiation necrosis with pathologic transformation of benign meningioma following adjuvant gamma knife radiosurgery: A rare case report. Medicine (Baltimore) 2020; 99:e21637. [PMID: 32756218 PMCID: PMC7402780 DOI: 10.1097/md.0000000000021637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Bevacizumab has shown good efficacy in radiation necrosis (RN) following gamma knife radiosurgery (GKRS) and associated peritumoral edema. However, few studies have reported bevacizumab failure. Moreover, the pathologic transformation of benign meningioma following GKRS has never been reported. PATIENTS CONCERNS A 41-year-old man was admitted with focal seizure on the right arm. DIAGNOSES Magnetic resonance imaging (MRI) demonstrated a 4.7 cm-sized convexity meningioma involving left motor cortex. INTERVENTIONS Subtotally resected tumor was confirmed as a meningothelial meningioma and subsequently treated by GKRS. During 4-year follow-up after GKRS, seizure and hemiparesis had persisted with progressively worsened peritumoral edema regardless of steroid and bevacizumab treatment. Radical debulking of tumor was achieved and immunohistopathological examination revealed angiomatous meningioma with necrotic core presenting scanty VEGF expression. OUTCOMES A follow-up MRI at 4 months after debulking surgery showed a marked reduction of peritumoral edema with improvement of symptoms. LESSONS This is the first report of pathologically confirmed angiomatous transformation following GKRS. Although the pathogenesis is not fully understood, this rare pathologic transformation may be closely related to RN. Also, if bevacizumab is resistant, debulking surgery for reducing tumor burden could be an effective treatment option to control the RN.
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Affiliation(s)
| | | | - Kyung-Hwa Lee
- Department of Pathology, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Jeollanam-do, South Korea
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Scerrati A, Mongardi L, Visani J, Lofrese G, Cavallo MA, Fiorentino A, De Bonis P. The controversial role of Bevacizumab in the treatment of patients with intracranial meningioma: a comprehensive literature review. Expert Rev Anticancer Ther 2020; 20:197-203. [PMID: 32116057 DOI: 10.1080/14737140.2020.1736567] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Meningiomas represent the most common primary intracranial tumors. Today, surgical resection, followed by radiotherapy when indicated, is still the treatment of choice. In recent years, distinct oncogenic pathways have been identified, laying the foundations of new personalized targeted therapies.Areas covered: The aim of this study was to highlight the effects, complications, possible associations with other therapeutic approaches and multi-parametric outcome evaluation of Bevacizumab for the treatment of meningiomas. A literature review according to PRISMA criteria regarding the role of Bevacizumab for the treatment of various WHO grades of meningiomas was performed. 15 relevant papers, including 6 retrospective clinical trial series, 3 prospective trials, and 6 single patient case reports for a total of 134 patients and 211 meningiomas were include.Expert opinion: Because of the lack of strong clinical evidence about improved survival and related toxicity, the use of Bevacizumab for the treatment of meningiomas should be carefully evaluated. Further exploration, ideally with randomized controlled trials, is needed to better define the role of this drug in the treatment of meningiomas.
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Affiliation(s)
- Alba Scerrati
- Neurosurgery, Department of Morphology, Surgery and Experimental Medicine, University Hospital S. Anna, Ferrara, Italy.,Neurosurgery Department, San Bortolo Hospital, Vicenza, Italy
| | - Lorenzo Mongardi
- Neurosurgery, Department of Morphology, Surgery and Experimental Medicine, University Hospital S. Anna, Ferrara, Italy
| | - Jacopo Visani
- Neurosurgery, Department of Morphology, Surgery and Experimental Medicine, University Hospital S. Anna, Ferrara, Italy
| | - Giorgio Lofrese
- Neurosurgery Division, "M. Bufalini" Hospital, Cesena, Italy
| | - Michele Alessandro Cavallo
- Neurosurgery, Department of Morphology, Surgery and Experimental Medicine, University Hospital S. Anna, Ferrara, Italy
| | - Alba Fiorentino
- Radiation Oncology Department, General Regional Hospital "F. Miulli", Acquaviva Delle Fonti, Italy
| | - Pasquale De Bonis
- Neurosurgery, Department of Morphology, Surgery and Experimental Medicine, University Hospital S. Anna, Ferrara, Italy
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Hong CS, Beckta JM, Kundishora AJ, Elsamadicy AA, Chiang VL. Laser Interstitial Thermotherapy for Treatment of Symptomatic Peritumoral Edema After Radiosurgery for Meningioma. World Neurosurg 2020; 136:295-300. [PMID: 32001396 DOI: 10.1016/j.wneu.2020.01.143] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/16/2020] [Accepted: 01/18/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Symptomatic peritumoral edema (PTE) is a known complication after radiosurgical treatment of meningiomas. Although the edema in most patients can be successfully managed conservatively with corticosteroid therapy or bevacizumab, some medically refractory cases may require surgical resection of the underlying lesion when feasible. Laser interstitial thermotherapy (LITT) continues to gain traction as an effective therapeutic modality for the treatment of radiation necrosis where its biggest impact is through the control of peritumoral edema. CASE DESCRIPTION A 56-year-old woman with neurofibromatosis 2 presented with a symptomatic, regrowing left frontotemporal lesion that had previously been radiated, then resected with confirmed recurrence of grade I meningioma, and subsequently radiated again for lesion recurrence. Given her history of 2 prior same-side craniotomies, including a complication of wound infection, she was not a candidate for further open surgical resection. Having failed conservative management, she underwent LITT with intraoperative biopsy demonstrating viable grade I meningioma. Postoperatively, she demonstrated radiographic marked, serial reduction of PTE and experienced resolution of her symptoms. CONCLUSIONS This case demonstrates that LITT may be a viable alternative treatment for patients with meningioma with symptomatic PTE who have failed medical therapy and require surgical intervention.
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Affiliation(s)
- Christopher S Hong
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jason M Beckta
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Adam J Kundishora
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Aladine A Elsamadicy
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Veronica L Chiang
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA; Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut, USA.
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8
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Franke AJ, Skelton IV WP, Woody LE, Bregy A, Shah AH, Vakharia K, Komotar RJ. Role of bevacizumab for treatment-refractory meningiomas: A systematic analysis and literature review. Surg Neurol Int 2018; 9:133. [PMID: 30090665 PMCID: PMC6057170 DOI: 10.4103/sni.sni_264_17] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 05/22/2018] [Indexed: 01/17/2023] Open
Abstract
Background Meningiomas are the most prevalent primary tumor of the central nervous system (CNS), and although the majority of these neoplasms are classified as benign, nearly one fourth of the lesions display an aggressive profile characterized by pleomorphic histology, high recurrence rates, and overall resistance to standard treatment. Despite the ubiquitous nature of these tumors, no adjuvant therapeutic regimen has been identified which effectively controls disease recurrence and progression after surgery and radiation, leading to a dismal prognosis in this patient population. The primary focus of this research study is, hence, to assess the recently emerging use of bevacizumab, an anti-angiogenic agent, in the treatment of meningiomas. This systematic literature review analyzes the efficacy and safety of therapeutic bevacizumab for treatment-refractory meningiomas. Methods A systematic PubMed search was conducted according to PRISMA guidelines to identify all relevant reports investigating the anti-angiogenic agent bevacizumab in the treatment of intracranial meningiomas. The reported parameters from pertinent retrospective reviews, prospective studies, and case studies were volumetric reduction, radiographic response, clinical stability, overall survival (OS), and progression free survival (PFS) measured at 6 and 12 months postinitiation of treatment. Complications were cataloged based on the range and severity of the therapy-related toxicities. Results A total of 11 articles, 5 retrospective series, 2 prospective trials, and 4 case reports, reporting on a total of 92 patients, were included in this review. The use of bevacizumab therapy for intracranial meningiomas demonstrated median overall PFS of 16.8 months (range: 6.5-22 months) and PFS-6 of 73% (range: 44%-93%). Conclusions Therapeutic bevacizumab, either alone or with combination chemotherapies, for select patient populations with recurrent or progressive meningiomas, offers a treatment option that confers improved overall progression-free survival. To assess OS parameters, larger randomized controlled trials assessing the use of anti-angiogenic agents for recurrent/progressive meningiomas are warranted.
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Affiliation(s)
- Aaron J. Franke
- Department of Internal Medicine, University of Florida College of Medicine, Gainesville, USA
| | - William Paul Skelton IV
- Department of Internal Medicine, University of Florida College of Medicine, Gainesville, USA
| | | | - Amade Bregy
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ashish H. Shah
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Kunal Vakharia
- Department of Neurological Surgery, University at Buffalo School of Medicine, Buffalo, New York, USA
| | - Ricardo J. Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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9
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Xiangying M, Rugang Z, Lijuan D, Yaowei Z, Bing S, Junliang W, Dan L, Shikai W. Low-dose bevacizumab as an effective pre-treatment for peri-tumoral brain edema prior to CyberKnife radiosurgery: A case report. Cancer Biol Ther 2018; 19:461-464. [PMID: 29420112 DOI: 10.1080/15384047.2018.1433499] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
A 75-y-old Chinese female patient diagnosed with lung adenocarcinoma with brain metastasis suffered severe nausea and vomiting, and these symptoms were contraindications for CyberKnife treatment. Neither mannitol, nor dexamethasone, relieved the symptoms. However, after the patient received a single dose of bevacizumab (200 mg, 2.9 mg/kg), the patient's symptoms were significantly relieved. The patient subsequently completed a successful CyberKnife treatment. In addition, the patient received an oral treatment of gefitinib. At 15 months post treatment, the patient's brain tumor was controlled. Thus, administration of bevacizumab at a low dose (2.9 mg/kg) may significantly alleviate peri-tumoral brain edema and its symptoms, thereby facilitating radiosurgery treatment.
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Affiliation(s)
- Meng Xiangying
- a Radiotherapy Department , 307 Hospital of PLA , #8 Dongda Street, Fengtai District , Beijing , China
| | - Zhao Rugang
- b Radiotherapy Department , Navy General Hospital , Beijing , China
| | - Ding Lijuan
- a Radiotherapy Department , 307 Hospital of PLA , #8 Dongda Street, Fengtai District , Beijing , China
| | - Zhao Yaowei
- a Radiotherapy Department , 307 Hospital of PLA , #8 Dongda Street, Fengtai District , Beijing , China
| | - Sun Bing
- a Radiotherapy Department , 307 Hospital of PLA , #8 Dongda Street, Fengtai District , Beijing , China
| | - Wang Junliang
- a Radiotherapy Department , 307 Hospital of PLA , #8 Dongda Street, Fengtai District , Beijing , China
| | - Li Dan
- a Radiotherapy Department , 307 Hospital of PLA , #8 Dongda Street, Fengtai District , Beijing , China
| | - Wu Shikai
- c Radiotherapy Department , 307 Hospital of PLA , Beijing , China
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10
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Arnold KM, Flynn NJ, Raben A, Romak L, Yu Y, Dicker AP, Mourtada F, Sims-Mourtada J. The Impact of Radiation on the Tumor Microenvironment: Effect of Dose and Fractionation Schedules. CANCER GROWTH AND METASTASIS 2018; 11:1179064418761639. [PMID: 29551910 PMCID: PMC5846913 DOI: 10.1177/1179064418761639] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 10/23/2017] [Indexed: 02/06/2023]
Abstract
In addition to inducing lethal DNA damage in tumor and stromal cells, radiation can alter the interactions of tumor cells with their microenvironment. Recent technological advances in planning and delivery of external beam radiotherapy have allowed delivery of larger doses per fraction (hypofractionation) while minimizing dose to normal tissues with higher precision. The effects of radiation on the tumor microenvironment vary with dose and fractionation schedule. In this review, we summarize the effects of conventional and hypofractionated radiation regimens on the immune system and tumor stroma. We discuss how these interactions may provide therapeutic benefit in combination with targeted therapies. Understanding the differential effects of radiation dose and fractionation can have implications for choice of combination therapies.
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Affiliation(s)
- Kimberly M Arnold
- Center for Translational Cancer Research, Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System, Newark, DE, USA.,Department of Medical Laboratory Sciences, University of Delaware, Newark, DE, USA
| | - Nicole J Flynn
- Center for Translational Cancer Research, Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System, Newark, DE, USA.,Department of Biological Sciences, University of Delaware, Newark, DE, USA
| | - Adam Raben
- Department of Radiation Oncology, Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System, Newark, DE, USA
| | - Lindsay Romak
- Department of Radiation Oncology, Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System, Newark, DE, USA
| | - Yan Yu
- Department of Radiation Oncology, Sidney Kimmel Medical College & Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Adam P Dicker
- Department of Radiation Oncology, Sidney Kimmel Medical College & Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Firas Mourtada
- Department of Radiation Oncology, Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System, Newark, DE, USA.,Department of Radiation Oncology, Sidney Kimmel Medical College & Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jennifer Sims-Mourtada
- Center for Translational Cancer Research, Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System, Newark, DE, USA.,Department of Medical Laboratory Sciences, University of Delaware, Newark, DE, USA.,Department of Biological Sciences, University of Delaware, Newark, DE, USA
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11
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Meng X, Zhao R, Shen G, Dong D, Ding L, Wu S. Efficacy and safety of bevacizumab treatment for refractory brain edema: Case report. Medicine (Baltimore) 2017; 96:e8280. [PMID: 29095257 PMCID: PMC5682776 DOI: 10.1097/md.0000000000008280] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE This retrospective study investigated the efficacy and safety of bevacizumab treatment for refractory brain edema. METHODS Between March 2009 and December 2015, bevacizumab was used to treat 59 cases of brain metastatic patients with refractory brain edema. The median dose of bevacizumab was 4.68 mg/kg (range 2.8-6.52 mg/kg). The clinical-pathological data, the efficacy, and the side effects of bevacizumab were recorded. Magnetic resonance imaging (MRI) was performed before and after bevacizumab treatment. Tumor and edema volumes were measured separately. RESULTS The clinical symptoms of 50 out of 59 cases (84.74%) improved the day after the bevacizumab treatment, and the edema volumes of 55 (93.22%) cases were reduced after the bevacizumab treatment. The average edema volume was significantly reduced after bevacizumab treatment from 125,583.43 ± 14,093.27 to 71,613.42 ± 9473.42 mm (Mann-Whitney rank test, P < .01), and the average edema index was significantly reduced from 25.66 ± 11.54 to 17.87 ± 6.87 (Mann-Whitney rank test, P < .01). One patient died from a hemorrhage due to a cancerous-ulcer of the maxillary sinus. The main complication observed was hypertension, which was observed in 11 cases (18.6%). CONCLUSION The effective rate of bevacizumab for refractory brain edema is 84.74%. Hypertension was the main side effect of the bevacizumab treatment. Bevacizumab is an effective and relatively safe treatment for brain edema.
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Affiliation(s)
- Xiangying Meng
- Radiotherapy Department, Affiliated Hospital of Academy of Military Medical Sciences
| | - Rugang Zhao
- Radiotherapy Department, Navy General Hospital
| | - Ge Shen
- Radiotherapy Department, Affiliated Hospital of Academy of Military Medical Sciences
| | - Dapeng Dong
- Radiotherapy Department, Affiliated Hospital of Academy of Military Medical Sciences
| | - Lijuan Ding
- Radiotherapy Department, Affiliated Hospital of Academy of Military Medical Sciences
| | - Shikai Wu
- Radiotherapy Department, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, China
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12
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Meng X, Zhao R, Wu S, Shen G, Ding L, Sun B, Wang J. Efficacy of repeated low-dose bevacizumab treatment with long-dosing interval for radiation-induced brain necrosis: A case report. Cancer Biol Ther 2017; 18:63-66. [PMID: 28152324 DOI: 10.1080/15384047.2016.1276127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
A 40-year-old Chinese female patient, with radiation-induced brain necrosis after radiosurgery, was treated 6 times with a single dose of 200 mg (3.27 mg/kg) bevacizumab each time, and with an interval of 12-16 weeks between each treatment. Neurological symptoms such as dizziness, fatigue, and headache disappeared after each administration of bevacizumab. The results suggest that repeated bevacizumab treatment using a low-dose and long-dosing interval may significantly alleviate radiation necrosis and its symptoms.
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Affiliation(s)
- Xiangying Meng
- a Department of Radiation Oncology , Affiliated Hospital of Academy of Military Medical Sciences , Beijing , China
| | - Rugang Zhao
- b Radiotherapy Department , Navy General Hospital , Beijing , China
| | - Shikai Wu
- a Department of Radiation Oncology , Affiliated Hospital of Academy of Military Medical Sciences , Beijing , China
| | - Ge Shen
- a Department of Radiation Oncology , Affiliated Hospital of Academy of Military Medical Sciences , Beijing , China
| | - Lijuan Ding
- a Department of Radiation Oncology , Affiliated Hospital of Academy of Military Medical Sciences , Beijing , China
| | - Bing Sun
- a Department of Radiation Oncology , Affiliated Hospital of Academy of Military Medical Sciences , Beijing , China
| | - Junliang Wang
- a Department of Radiation Oncology , Affiliated Hospital of Academy of Military Medical Sciences , Beijing , China
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13
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Turner RC, Lucke-Wold BP, Josiah D, Gonzalez J, Schmidt M, Tarabishy AR, Bhatia S. Stereotactic radiosurgery planning based on time-resolved CTA for arteriovenous malformation: a case report and review of the literature. Acta Neurochir (Wien) 2016; 158:1555-62. [PMID: 27334738 PMCID: PMC4944162 DOI: 10.1007/s00701-016-2874-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 06/02/2016] [Indexed: 02/05/2023]
Abstract
Stereotactic radiosurgery has long been recognized as the optimal form of management for high-grade arteriovenous malformations not amenable to surgical resection. Radiosurgical plans have generally relied upon the integration of stereotactic magnetic resonance angiography (MRA), standard contrast-enhanced magnetic resonance imaging (MRI), or computed tomography angiography (CTA) with biplane digital subtraction angiography (DSA). Current options are disadvantageous in that catheter-based biplane DSA is an invasive test associated with a small risk of complications and perhaps more importantly, the two-dimensional nature of DSA is an inherent limitation in creating radiosurgical contours. The necessity of multiple scans to create DSA contours for radiosurgical planning puts patients at increased risk. Furthermore, the inability to import two-dimensional plans into some radiosurgery programs, such as Cyberknife TPS, limits treatment options for patients. Defining the nidus itself is sometimes difficult in any of the traditional modalities as all draining veins and feeding arteries are included in the images. This sometimes necessitates targeting a larger volume, than strictly necessary, with stereotactic radiosurgery for treatment of the AVM. In this case report, we show the ability to use a less-invasive and three-dimensional form of angiography based on time-lapsed CTA (4D-CTA) rather than traditional DSA for radiosurgical planning. 4D-CTA may allow generation of a series of images, which can show the flow of contrast through the AVM. A review of these series may allow the surgeon to pick and use a volume set that best outlines the nidus with least interference from feeding arteries or draining veins. In addition, 4D-CTA scans can be uploaded into radiosurgery programs and allow three-dimensional targeting. This is the first reported case demonstrating the use of a 4D CTA and an MRI to delineate the AVM nidus for Gamma Knife radiosurgery, with complete obliteration of the nidus over time and subsequent management of associated radiation necrosis with bevacizumab.
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Affiliation(s)
- Ryan C Turner
- Department of Neurosurgery, West Virginia University School of Medicine, One Medical Center Drive, Suite 9183, Morgantown, WV, 26506, USA
- Center for Neuroscience, West Virginia University School of Medicine, Morgantown, WV, 26506, USA
| | - Brandon P Lucke-Wold
- Department of Neurosurgery, West Virginia University School of Medicine, One Medical Center Drive, Suite 9183, Morgantown, WV, 26506, USA
- Center for Neuroscience, West Virginia University School of Medicine, Morgantown, WV, 26506, USA
| | - Darnell Josiah
- Department of Neurosurgery, West Virginia University School of Medicine, One Medical Center Drive, Suite 9183, Morgantown, WV, 26506, USA
- Center for Neuroscience, West Virginia University School of Medicine, Morgantown, WV, 26506, USA
| | - Javier Gonzalez
- Department of Neurology, West Virginia University School of Medicine, Morgantown, WV, 26506, USA
| | - Matthew Schmidt
- Department of Radiology, West Virginia University School of Medicine, Morgantown, WV, 26506, USA
| | - Abdul Rahman Tarabishy
- Department of Radiology, West Virginia University School of Medicine, Morgantown, WV, 26506, USA
| | - Sanjay Bhatia
- Department of Neurosurgery, West Virginia University School of Medicine, One Medical Center Drive, Suite 9183, Morgantown, WV, 26506, USA.
- Center for Neuroscience, West Virginia University School of Medicine, Morgantown, WV, 26506, USA.
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Furuse M, Nonoguchi N, Kawabata S, Miyatake SI, Kuroiwa T. Delayed brain radiation necrosis: pathological review and new molecular targets for treatment. Med Mol Morphol 2015; 48:183-90. [DOI: 10.1007/s00795-015-0123-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 10/01/2015] [Indexed: 12/20/2022]
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