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Comparative analysis of bevacizumab and LITT for treating radiation necrosis in previously radiated CNS neoplasms: a systematic review and meta-analysis.
Gecici, Neslihan Nisa; Gurses, Muhammet Enes; Kaye, Brandon; Jimenez, Natasha L Frontera; Berke, Chandler; Gökalp, Elif; Lu, Victor M; Ivan, Michael E; Komotar, Ricardo J; Shah, Ashish H.
Afiliação
  • Gecici NN; Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, US.
  • Gurses ME; Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, US. megursesmd@gmail.com.
  • Kaye B; Dr. Kiran C. Patel College of Allopathic Medicine, Davie, FL, 33326, US.
  • Jimenez NLF; Department of Neurosurgery, University of Puerto Rico School of Medicine, San Juan, Puerto Rico.
  • Berke C; Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, US.
  • Gökalp E; Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, US.
  • Lu VM; Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, US.
  • Ivan ME; Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, US.
  • Komotar RJ; Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, US.
  • Shah AH; Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, US.
J Neurooncol ; 168(1): 1-11, 2024 May.
Article em En | MEDLINE | ID: mdl-38619777
ABSTRACT

PURPOSE:

Radiation necrosis (RN) is a local inflammatory reaction that arises in response to radiation injury and may cause significant morbidity. This study aims to evaluate and compare the efficacy of bevacizumab and laser interstitial thermal therapy (LITT) in treating RN in patients with previously radiated central nervous system (CNS) neoplasms.

METHODS:

PubMed, Cochrane, Scopus, and EMBASE databases were screened. Studies of patients with radiation necrosis from primary or secondary brain tumors were included. Indirect meta-analysis with random-effect modeling was performed to compare clinical and radiological outcomes.

RESULTS:

Twenty-four studies were included with 210 patients in the bevacizumab group and 337 patients in the LITT group. Bevacizumab demonstrated symptomatic improvement/stability in 87.7% of cases, radiological improvement/stability in 86.2%, and steroid wean-off in 45%. LITT exhibited symptomatic improvement/stability in 71.2%, radiological improvement/stability in 64.7%, and steroid wean-off in 62.4%. Comparative analysis revealed statistically significant differences favoring bevacizumab in symptomatic improvement/stability (p = 0.02), while no significant differences were observed in radiological improvement/stability (p = 0.27) or steroid wean-off (p = 0.90). The rates of adverse reactions were 11.2% for bevacizumab and 14.9% for LITT (p = 0.66), with the majority being grade 2 or lower (72.2% for bevacizumab and 62.5% for LITT).

CONCLUSION:

Both bevacizumab and LITT exhibited favorable clinical and radiological outcomes in managing RN. Bevacizumab was found to be associated with better symptomatic control compared to LITT. Patient-, diagnosis- and lesion-related factors should be considered when choosing the ideal treatment modality for RN to enhance overall patient outcomes.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Lesões por Radiação / Bevacizumab / Necrose Limite: Humans Idioma: En Revista: J Neurooncol Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Lesões por Radiação / Bevacizumab / Necrose Limite: Humans Idioma: En Revista: J Neurooncol Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Estados Unidos