This case report shows that real-time MRI may aid in the precision of intra-arterial delivery of bevacizumab to butterfly glioblastoma. Fast clinical improvement, decrease of contrast enhancing status, and no serious adverse effects were observed at discharge from hospital. The patient regained pre-recurrent neurological status for 2 months with a subsequent fast clinical decline and an increase in tumor volume. The patient underwent a second procedure of intra-arterial delivery of bevacizumab to the brain, with substantial clinical and radiological improvement, but not the level of improvement observed after the first procedure. Another clinical decline occurred with an increase in tumor size and the patient was treated 2 months later with a third intra-arterial infusion of bevacizumab. While another positive effect was achieved, it was less pronounced than before, and the patient died 1.5 months later. There were no technical, ischemic or other complications during the procedures. The patient survived 218 days from the first symptoms of tumor recurrence, 190 days from the first MRI, and 175 days from the first intra-arterial treatment of bevacizumab.
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Contributors MZ: planned the treatment and performed the procedure, analyzed the data and edited the manuscript. JW, BK: planned the treatment and edited the manuscript. KK: planned the treatment and took care of the patient on a daily basis. PW: planned the procedure, analyzed the data, edited the manuscript and prepared the figure. MJ: planned the treatment and performed the procedure, analyzed the data, drafted the manuscript and approved its final form.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests PW and MJ are co-owners of IntraART, LLC and Ti-com, LLC, but they are not directly related to this case report.
Provenance and peer review Not commissioned; externally peer reviewed.