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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
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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
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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
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Journal Article
Comparative analysis of bevacizumab and LITT for treating radiation necrosis in previously radiated CNS neoplasms: a systematic review and meta-analysis
2024
Overview
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.
Publisher
Springer US,Springer Nature B.V
Subject
Angiogenesis Inhibitors - therapeutic use
/ Antineoplastic Agents, Immunological - adverse effects
/ Antineoplastic Agents, Immunological - therapeutic use
/ Bevacizumab - therapeutic use
/ Central Nervous System Neoplasms - drug therapy
/ Central Nervous System Neoplasms - radiotherapy
/ Central Nervous System Neoplasms - therapy
/ Humans
/ Medicine
/ Necrosis
/ Oncology
/ Patients
/ Radiation Injuries - drug therapy
/ Radiation Injuries - etiology
/ Radiation Injuries - pathology
/ Review
/ Steroids
/ Tumors
