From the Guidelines
Treatment for radiation-induced brain scar tissue (radiation necrosis) that has stabilized after 18 months typically involves a multifaceted approach, with bevacizumab (Avastin) being the primary medication used, as supported by recent studies 1. The treatment approach for radiation necrosis is focused on reducing inflammation, improving blood flow, and minimizing further tissue damage.
- Bevacizumab is typically administered at 5-10 mg/kg intravenously every 2-3 weeks for 4-6 cycles, though treatment duration varies based on response.
- Corticosteroids like dexamethasone (starting at 4-16 mg daily, then tapering) may help reduce inflammation and associated symptoms.
- Pentoxifylline (400 mg three times daily) combined with vitamin E (400 IU daily) has shown some benefit in reducing fibrosis, as noted in various studies 1.
- Hyperbaric oxygen therapy, consisting of 20-40 sessions breathing 100% oxygen in a pressurized chamber, may promote healing in some cases.
- Anticonvulsants are prescribed if seizures occur.
- For severe cases causing significant symptoms despite medical management, surgical resection of the necrotic tissue may be necessary, as suggested by recent guidelines 1. Regular follow-up MRI scans every 3-6 months are important to monitor treatment response and distinguish between radiation necrosis and potential tumor recurrence, highlighting the need for ongoing surveillance and management 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Options for Scar Tissue in the Brain from Radiation
- Bevacizumab has been shown to be a feasible therapeutic option for symptomatic radiation necrosis, either when traditional antiedematous steroid treatment fails, or as an alternative to steroid treatment 2.
- A systematic review and meta-analysis found that bevacizumab presents a promising treatment strategy for patients with radiation necrosis and brain metastatic disease, with radiographic response and clinical improvement observed without any serious adverse events 3.
- Anticoagulation with heparin and warfarin has also been used to treat late radiation-induced nervous system injuries, with some recovery of function occurring in patients with cerebral radionecrosis, myelopathy, or plexopathy 4.
Efficacy of Bevacizumab
- Studies have reported radiographic improvement in 83-93% of patients with radiation necrosis treated with bevacizumab, with a mean volume reduction of 47-62% on MRI images 3, 5, 6.
- Clinical improvement was observed in 48-91% of patients, with some patients experiencing complete resolution of symptoms 3, 5, 6.
- Bevacizumab has been shown to be effective in reducing the daily dose of dexamethasone, with a mean reduction of 9.4 mg per day 5.