A Case of Brain Necrosis after Stereotactic Irradiation for Brain Metastasis of Breast Cancer Treated with Bevacizumab

Abstract

A 44-year-old woman presented with hypochondriac pain. Abdominal ultrasonography revealed multiple metastatic liver tumors. Enhanced computed tomography revealed a left breast tumor in the upper lateral region 40 mm in size and multiple liver tumors in the S4/8 and left lateral segments. The pathological diagnosis based on the breast tumor on core needle biopsy was left invasive ductal carcinoma (human epidermal growth factor receptor 2 type). Two years after chemotherapy, follow-up magnetic resonance imaging (MRI) showed brain metastases in the left temporal lobe, left occipital lobe, and right cerebellum. She underwent a total of two courses of stereotactic radiation, and chemotherapy was continued. After a while, she suddenly developed awareness of dysarthria and right hemiplegia. MRI revealed brain radiation necrosis (BRN) in the left temporal lobe and left occipital lobe. After three courses of bevacizumab administration, her symptoms improved. Radiation therapy is the standard treatment for brain metastases. However, BRN is an severe complication that affects patients. A few studies have demonstrated the efficacy of bevacizumab in treating BRN. Our case showed the effectiveness of bevacizumab in improving neurological symptoms. Our clinical experience suggests that bevacizumab may be a valid treatment strategy for BRN.