TY  - JOUR
A1  - Voß, Martin
A1  - Batarfi, AbdulAziz
A1  - Steidl, Eike
A1  - Wagner, Marlies
A1  - Forster, Marie-Thérèse
A1  - Steinbach, Joachim Peter
A1  - Rödel, Claus
A1  - Bojunga, Jörg
A1  - Ronellenfitsch, Michael Wilfried
T1  - Adrenal insufficiency in patients with corticosteroid-refractory cerebral radiation necrosis treated with bevacizumab
T2  - Journal of Clinical Medicine
N2  - Cerebral radiation necrosis is a common complication of the radiotherapy of brain tumours that can cause significant mortality. Corticosteroids are the standard of care, but their efficacy is limited and the consequences of long-term steroid therapy are problematic, including the risk of adrenal insufficiency (AI). Off-label treatment with the vascular endothelial growth factor A antibody bevacizumab is highly effective in steroid-resistant radiation necrosis. Both the preservation of neural tissue integrity and the cessation of steroid therapy are key goals of bevacizumab treatment. However, the withdrawal of steroids may be impossible in patients who develop AI. In order to elucidate the frequency of AI in patients with cerebral radiation necrosis after treatment with corticosteroids and bevacizumab, we performed a retrospective study at our institution’s brain tumour centre. We obtained data on the tumour histology, age, duration and maximum dose of dexamethasone, radiologic response to bevacizumab, serum cortisol, and the need for hydrocortisone substitution for AI. We identified 17 patients with cerebral radiation necrosis who had received treatment with bevacizumab and had at least one available cortisol analysis. Fifteen patients (88%) had a radiologic response to bevacizumab. Five of the 17 patients (29%) fulfilled criteria for AI and required hormone substitution. Age, duration of dexamethasone treatment, and time since radiation were not statistically associated with the development of AI. In summary, despite the highly effective treatment of cerebral radiation necrosis with bevacizumab, steroids could yet not be discontinued due to the development of AI in roughly one-third of patients. Vigilance to spot the clinical and laboratory signs of AI and appropriate testing and management are, therefore, mandated.
KW  - adrenal insuffciency
KW  - Addison’s disease
KW  - bevacizumab
KW  - cerebral radiation necrosis
Y1  - 2019
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/52575
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-525758
SN  - 2077-0383
N1  - This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited
VL  - 8
IS  - 10, Art. 1608
SP  - 1
EP  - 9
PB  - MDPI
CY  - Basel
ER  -