Jiazhong Dai

Reversal of cerebral radiation necrosis with bevacizumab treatment in 17 Chinese patients

BackgroundBevacizumab has been suggested as a new treatment modality for cerebral radiation necrosis due to its ability to block the effects of vascular endothelial growth factor (VEGF) in leakage-prone capillaries, though its use still remains controversial in clinical practice.MethodsThe use of bevacizumab in 17 patients with symptomatic cerebral radiation necrosis poorly controlled with dexamethasone steroid treatments was examined between March 2010 and January 2012. Bevacizumab therapy was administered for a minimum of two cycles (7.5 mg/kg, at two-week interval) with a median of four bevacizumab injections. Changes in bi-dimensional measurements of the largest radiation necrosis lesions were observed by gadolinium-enhanced and T2-weighted magnetic resonance imaging (MRI). Additionally, dexamethasone dosage, Karnofsky performance status (KPS), adverse event occurrence and associated clinical outcomes were recorded for each patient.ResultsMRI analysis revealed that the average reduction was 54.9% and 48.4% in post-gadolinium and T2-weighted sequence analysis, respectively. Significant clinical neurological improvements were expressed in 10 patients according to KPS values. Dexamethasone reduction was achieved four weeks after initiation of bevacizumab in all patients, with four patients successfully discontinuing dexamethasone treatment. Mild to moderate bevacizumab-related adverse events, such as fatigue, proteinuria and hypertension were observed in three patients. Upon follow-up at 4 to 12 months, 10 patients showed clinical improvement, and 7 patient deaths occurred from tumor progression (5 patients), recurrent necrosis (1 patient), and uncontrolled necrosis-induced edema (1 patient).ConclusionsThese findings suggest bevacizumab as a promising treatment for cerebral radiation necrosis induced by common radiation therapies, including external beam radiotherapy (EBRT), stereotactic radiosurgery (SRS), and fractionated stereotactic radiotherapy (FSRT).

Phase II study to assess the efficacy of hypofractionated stereotactic radiotherapy in patients with large cavernous sinus hemangiomas.

PURPOSE Cavernous sinus hemangioma is a rare vascular tumor. The direct microsurgical approach usually results in massive hemorrhage. Although radiosurgery plays an important role in managing cavernous sinus hemangiomas as a treatment alternative to microsurgery, the potential for increased toxicity with single-session treatment of large tumors is a concern. The purpose of this study was to assess the efficacy of hypofractionated stereotactic radiotherapy in patients with large cavernous sinus hemangiomas. METHODS Fourteen patients with large (volume >20 cm(3)) cavernous sinus hemangiomas were enrolled in a prospective Phase II study between December 2007 and December 2010. The hypofractionated stereotactic radiotherapy dose was 21 Gy delivered in 3 fractions. RESULTS After a mean follow-up of 15 months (range, 6-36 months), the magnetic resonance images showed a mean of 77% tumor volume reduction (range, 44-99%). Among the 6 patients with cranial nerve impairments before hypofractionated stereotactic radiotherapy, 1 achieved symptomatic complete resolution and 5 had improvement. No radiotherapy-related complications were observed during follow-up. CONCLUSION Our current experience, though preliminary, substantiates the role of hypofractionated stereotactic radiotherapy for large cavernous sinus hemangiomas. Although a longer and more extensive follow-up is needed, hypofractionated stereotactic radiotherapy of 21 Gy delivered in 3 fractions is effective in reducing the tumor volume without causing any new deficits and can be considered as a treatment modality for large cavernous sinus hemangiomas.

Nimotuzumab, a humanized monoclonal antibody specific for the EGFR, in combination with temozolomide and radiation therapy for newly diagnosed glioblastoma multiforme: First results in Chinese patients

To evaluate the safety and efficacy of nimotuzumab, a humanized monoclonal antibody specific for the epidermal growth factor receptor (EGFR), in combination with temozolomide (TMZ) and radiation therapy (RT) in the treatment of newly diagnosed glioblastoma (GBM) in Chinese patients.

Hearing outcomes between multi-session and single-session radiosurgery for vestibular schwannoma: a single center study

Background: Hearing preservation rate after Gamma Knife radiosurgery (GKRS) for vestibular schwannoma (VS) remains low. The aim of this study was to study hearing outcomes between multisession and single session GKRS in patients with VS and determine prognostic factors associated with hearing preservation. Methods: A retrospective analysis of 561 consecutive patients with VS subjected to multisession (74 patients) or single session (487 patients) GKRS (from June 2011 to April 2015) was performed. Propensity score matching (PSM) based on patient age, gender, tumor volume and pre-GKRS hearing was used to compare the two groups. The tumor control rate and complications were evaluated, especially hearing preservation and its prognostic factors. Results: According to PSM, 29 patients from each group with similar characteristics were selected for the study. Patients’ age, tumor volume, pre-GKRS pure tone average (PTA) and radiographic follow-up period were not significantly different between the two groups (P>0.05). The tumor control rate was 75.9% for the multisession group compared with 62.1% for the single session group (P=0.1142); 20 patients had a less than 20 dB change in PTA in multisession group, with the hearing preservation rate of 69.0% (20/29) compared with 65.5% (19/29) in single session group (P=0.08). Multivariate analysis revealed that linear internal auditory canal (IAC) length was the only significant predictor of hearing loss in the multisession group. At last follow-up, one patient complaining of sudden hearing loss was diagnosed with tumor bleeding 12 months after multisession GKRS. One patient from multisession group and two patients from single session group suffered from temporal facial numbness. Facial spasm developed in one patient after multisession GKRS. Conclusions: Our results supported that multisession GKRS could be an effective and safe treatment option for VS compared to single session GKRS. The hearing preservation rate after multisession GKRS was not superior to single session radiosurgery in our short-term follow-up study. However, patients with longer IAC length may benefit from multisession strategy in terms of hearing preservation.