gms | German Medical Science

61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

Response of a recurrent anaplastic meningioma to Bevacizumab

Meeting Abstract

  • Maximilian J. A. Puchner - Neurochirurgische Klinik, Klinikum Vest GmbH – Knappschaftskrankenhaus Recklinghausen, Germany
  • Volkmar H. Hans - Institut für Neuropathologie, Evangelisches Krankenhaus Bielefeld, Germany
  • Martin Glas - Schwerpunkt Klinische Neuroonkologie, Neurologische Klinik, Universitätsklinikum Bonn, Germany
  • Ali Harati - Neurochirurgische Klinik, Klinikum Vest GmbH – Knappschaftskrankenhaus Recklinghausen, Germany
  • Frauke Lohmann - Neurochirurgische Klinik, Klinikum Vest GmbH – Knappschaftskrankenhaus Recklinghausen, Germany
  • Ulrich Herrlinger - Schwerpunkt Klinische Neuroonkologie, Neurologische Klinik, Universitätsklinikum Bonn, Germany

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocP1750

DOI: 10.3205/10dgnc221, URN: urn:nbn:de:0183-10dgnc2214

Published: September 16, 2010

© 2010 Puchner et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objective: Standard therapy for anaplastic meningiomas consists of surgery and radiotherapy. This treatment results in a median survival time of 15 months. Various attempts to treat those tumors by chemotherapeutic drugs failed. As meningiomas are highly vascularized tumors and produce high levels of vascular-endothelial growth factor (VEGF) the treatment of a recurrent anaplastic meningioma by the antiangiogenic acting VEGF-A antibody bevacizumab seemed to be promising.

Methods: A 52-years-old female patient developed a progressive psychoorganic syndrome and dysphasia. In addition visual field defects were found. An MRI-scan revealed a large contrast-enhancing intraventricular tumor in the left trigonum that could be removed completely. Histologically, the tumor was diagnosed to be an anaplastic meningioma, WHO grade III. Therefore postoperative radiotherapy (60 Gy) was performed. 15 months after surgery a small, asymptomatic, local recurrent tumor was found in a follow-up MRI. As second-line surgery or re-irradiation was regarded as inappropriate, an experimental therapy with bevacizumab 10 mg/kg body weight every 2 weeks was started.

Results: Already at the first followup MRI 6 weeks after starting bevacizumab, the contrast-enhancing tumor has regressed substantially indicating a partial response. Also, the hyperintense lesions on FLAIR and T2-weighted MRIs had slightly regressed. The followup MRI 6 months after the start of bevacizumab continues to show a partial remission. Bevacizumab therapy was tolerated without any side effects so far.

Conclusions: This is the first report of a therapy-induced partial remission of a malignant meningioma induced by antiangiogenic therapy. The fact that the regression did not only include the contrast-enhanced T1 lesions but also the T2 hyperintensities in the center of the tumor (not only the peripheral edema zone) suggests a true tumor regression beyond mere vascular effects leaving an avascular/hypovascular tumor without affecting the tumor cells itself. Since anaplastic meningioma is a rare but devastating disease and since there is no established medical therapy in this disease, the therapeutic success presented here is substantial. Thus, on the base of the presented case, bevacizumab therapy has to be explored further for this indication.