Coming of age of bevacizumab in the management of radiationinduced cerebral necrosis

Melvin L. K. Chua, Kevin L. M. Chua, Joseph T. S. Wee


Radiotherapy is an integral modality in the curative treatment of head and neck and nasopharynx cancers (NPCs) (1). Nonetheless, despite the advent of more conformal techniques of radiation delivery, head and neck cancer patients still suffer from late adverse events, which include potential debilitating neurological injury like cranial neuropathies and radiation-induced brain necrosis (RN). In particular for the management of the latter, protracted use of high dose corticosteroids has been the conventional treatment for RN, albeit with limited efficacy and significant side effects. Additionally, evidence surrounding other treatments such as hyperbaric oxygen and anticoagulation is scant and based on uncontrolled case series (2).