{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T13:10:40Z","timestamp":1791724240707,"version":"4.3.4"},"reference-count":89,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2025,6,5]],"date-time":"2025-06-05T00:00:00Z","timestamp":1749081600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Consortium Grant from the Dutch Cancer Society","award":["14642"],"award-info":[{"award-number":["14642"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Cerebral radiation necrosis (CRN) is a serious complication of high-dose radiotherapy in patients with high-grade glioma (HGG) and brain metastases (BM). Approximately half of the patients with radiological CRN develop debilitating neurological symptoms that significantly affect their neurocognitive functioning, performance status, and health-related quality of life (HRQoL), requiring treatment. While corticosteroids are the standard first-line treatment for symptomatic CRN (sCRN), they have considerable drawbacks, including limited efficacy, severe side effects affecting various organ systems, and interference with concurrent therapies, such as immunotherapy. Prolonged corticosteroid use can lead to adrenal insufficiency and dependence on hormone replacement. Bevacizumab has been shown to reduce the contrast-enhancing CRN lesion on MRI and surrounding edema, improving clinical outcomes in most patients. However, most evidence comes from smaller, single-center, retrospective studies focusing on short-term radiological and clinical outcomes, typically in patients already treated with corticosteroids. Information on the optimal timing of bevacizumab administration and its long-term effects and impact on patient-reported outcomes, including HRQoL, is lacking. These limitations prevented the adoption of first-line bevacizumab treatment for sCRN in international guidelines and insurance coverage policies. A well-powered prospective clinical trial comparing the clinical and cost-effectiveness of first-line bevacizumab versus corticosteroids in HGG and BM patients is essential.<\/jats:p>","DOI":"10.1093\/nop\/npaf059","type":"journal-article","created":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T20:41:45Z","timestamp":1749069705000},"page":"747-762","source":"Crossref","is-referenced-by-count":7,"title":["Bevacizumab for symptomatic cerebral radiation necrosis after radiation of high-grade glioma or brain metastases \u2013 when and for whom?"],"prefix":"10.1093","volume":"12","author":[{"given":"Lente L","family":"Kroon","sequence":"first","affiliation":[{"name":"Department of Neuro-Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek , Amsterdam ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edith M T","family":"Dieleman","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Amsterdam University Medical Center , Amsterdam ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vera C","family":"Keil","sequence":"additional","affiliation":[{"name":"Cancer Center Amsterdam, Imaging and Biomarkers , Amsterdam ,","place":["The Netherlands"]},{"name":"Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center , Amsterdam ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4672-2477","authenticated-orcid":false,"given":"Marit","family":"van Barreveld","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Data Science, Amsterdam University Medical Center, University of Amsterdam , Amsterdam ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel G W","family":"Dijkgraaf","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Data Science, Amsterdam University Medical Center, University of Amsterdam , Amsterdam ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurens","family":"Topff","sequence":"additional","affiliation":[{"name":"Department of Radiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek , Amsterdam ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sander N","family":"Wagemakers","sequence":"additional","affiliation":[{"name":"Department of Neurology, Groene Hart Hospital , Gouda ,","place":["The Netherlands"]},{"name":"Department of Neuro-Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek , Amsterdam ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom J","family":"Snijders","sequence":"additional","affiliation":[{"name":"Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University , Utrecht ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maaike J","family":"Vos","sequence":"additional","affiliation":[{"name":"Department of Neurology, Leiden University Medical Center , Leiden ,","place":["The Netherlands"]},{"name":"Department of Neurology, Haaglanden Medical Center , The Hague ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johan A F","family":"Koekkoek","sequence":"additional","affiliation":[{"name":"Department of Neurology, Leiden University Medical Center , Leiden ,","place":["The Netherlands"]},{"name":"Department of Neurology, Haaglanden Medical Center , The Hague ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lukas J A","family":"Stalpers","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Amsterdam University Medical Center , Amsterdam ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filip Y F L","family":"de Vos","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Utrecht University Medical Center , Utrecht ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7998-9904","authenticated-orcid":false,"given":"Dieta","family":"Brandsma","sequence":"additional","affiliation":[{"name":"Department of Neuro-Oncology, Amsterdam University Medical Center , Amsterdam ,","place":["The Netherlands"]},{"name":"Department of Neuro-Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek , Amsterdam ,","place":["The 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