Low-dose bevacizumab as an effective pre-treatment for peri-tumoral brain edema prior to CyberKnife radiosurgery: A case report

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.

Keywords: Brain metastasis; bevacizumab; peri-tumoral brain edema; radiosurgery.

Figure 1.

MRI of a 75-y-old female with lung adenocarcinoma and brain metastasis at three time points. At time point 1 (16 February 2016), prior to treatment, a large region of edema was observed in the tissue surrounding the brain metastasis according to gadolinium-enhanced T1-weighted MRI (A) and T2-weighted FLAIR MRI (B). Following administration of a single dose of bevacizumab (2.9 mg/kg) on 19 February 2016, gadolinium-enhanced T1-weighted MRI (C) and T2-weighted MRI (D) were performed at time point 2 (23 February 2016) and the volume of edema was found to be reduced. After the patient received a CyberKnife treatment and gefitinib treatments for an additional 15 months, gadolinium-enhanced T1-weighted MRI (E) and T2-weighted MRI (F) performed at time point 3 (18 July 2017) showed the brain tumor was well controlled.

Figure 2.

Radiosurgery plan for the CyberKnife treatment that was administered (18 Gy in three fractions, 71% of isodose curve).