Bevacizumab for Radiation-Induced (Radiculo)plexopathy

Radiation-induced (radiculo)plexopathy [RI(R)P] is a debilitating delayed neurological adverse event occurring in cancer survivors years after the irradiation of the brachial or lumbar plexuses. No effective treatments have been identified to date. The objective of this work was to evaluate the effectiveness of the anti-VEGF bevacizumab in the treatment of RI(R)P.

We retrospectively identified patients diagnosed with contrast-enhancing RI(R)P and treated with bevacizumab in the setting of an institutionally sponsored expanded access program over the last 10 years. Clinical, radiological, and neurophysiological records were reviewed.

We identified nine patients manifesting with neurophysiological-confirmed RI(R)P (brachial plexopathy, 4; lumbosacral radiculoplexopathy, 5) after a median of 13 years from radiotherapy for their cancer. Symptoms included focal weakness, paresthesia, cramps, hypoesthesia, amyotrophy, and pain. Patients received bevacizumab at 7.5 mg/kg/q2 weeks for a median of six cycles (range, three to nine cycles). Clinical improvement was noted in three cases and clinical stabilization in two. Patients treated within 2 years since symptom onset appeared as most likely to benefit. Enhancement reduction on follow-up MRI was associated with the clinical benefit.

Bevacizumab could be effective in the treatment of RI(R)P, particularly when patients are managed early in their disease. Further prospective clinical trials are warranted to validate these results.