Evidence map›Paper›PMID 34177536›Full record

ArticleCase reports in neurology

Resolution of Radiation-Induced Necrosis in Arteriovenous Malformation with Bevacizumab: A Case Report and Review of Current Literature.

Forrest Kwong, Daphne B Scarpelli, Ramon F Barajas, Debra Monaco, James A Tanyi, Shearwood McClelland, Jerry J Jaboin

Open access · goldAbstract readCase Reports
In one paragraph

Article in Case reports in neurology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
–field-weighted citation impact, top 91% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it, 5 citations in OpenAlex.

  1. Pooled it
  2. Review
  3. Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 2 institutions in 1 country.

Forrest KwongSchool of Medicine, Oregon Health & Science University, Portland, Oregon, USA.
Daphne B ScarpelliDepartment of Radiation Medicine, Oregon Health & Science University, Portland, Oregon, USA.
Ramon F BarajasDepartment of Diagnostic Radiology, Oregon Health & Science University, Portland, Oregon, USA.
Debra MonacoDepartment of Radiation Medicine, Oregon Health & Science University, Portland, Oregon, USA.
James A TanyiDepartment of Radiation Medicine, Oregon Health & Science University, Portland, Oregon, USA.
Shearwood McClellandDepartment of Radiation Oncology, Indiana University, Indianapolis, Indiana, USA.
Jerry J JaboinDepartment of Radiation Medicine, Oregon Health & Science University, Portland, Oregon, USA.
Oregon Health & Science University · USIndiana University – Purdue University Indianapolis · US

Funding

Defining the Hypoxic Immunosuppressive Microenvironment as a Biomarker of Therapy Efficacy in Glioblastoma Using Iron Oxide Enhanced FMISO PET/MRIK08CA237809 · NCI · OREGON HEALTH & SCIENCE UNIVERSITY · PI BARAJAS, RAMON FRANCISCO · 2020 to 2024
$1.2M
NCI NIH HHS K08 CA237809NCI NIH HHS L30 CA220897
6 · The paper itself

Abstract

Stereotactic radiosurgery (SRS) is a proven treatment modality for inoperable arteriovenous malformations (AVMs). However, the rate of radiation-induced necrosis (RIN) is as high as 10%. A 6-year-old female patient presented with severe headache, emesis, and syncope, and workup revealed a Spetzler-Martin grade 4 AVM with intraventricular hemorrhage and hydrocephalus. The patient underwent a right frontal ventriculostomy followed by a linear accelerator-based SRS of 16.9 Gy. At 19 years, she developed progressive neurological symptoms. Diagnostic magnetic resonance imaging (MRI) revealed a recurrent parietal AVM nidus. We delivered the linear accelerator-based SRS of 18.5 Gy to the AVM nidus. Within 9 months, she experienced episodic headaches and left-sided weakness and spasticity; symptoms were initially managed with dexamethasone. Follow-up MRI was notable for edema and nondetectable blood flow, consistent with RIN and AVM obliteration. The second course of steroids did not provide the symptom control. Persistent RIN was noted on MRI, and she had stigmata of steroid toxicity (centripetal obesity, depression, and sleep disorder). Two infusions of bevacizumab (5 mg/kg) were administered concurrently with a tapering dose of dexamethasone. The patient noted a near immediate improvement in her headaches, and 2 months following the second bevacizumab infusion, she reported a near-complete resolution of her symptoms and displayed improved ambulation. The development of RIN remains a noteworthy concern post-SRS of AVMs. While steroids aid with initial management of RIN, for persistent and recurrent symptoms, bevacizumab infusions serve as a viable treatment course, with the added benefit of reducing the likelihood of adverse effects resulting from prolonged steroid therapy.

Indexed as

Arteriovenous malformationBevacizumabRadiation-induced necrosisStereotactic radiosurgery

Identifiers

PMID34177536
PMCPMC8215952
OpenAlexW3171055115

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.