A Case of Ramucirumab for Radiation Necrosis Following Stereotactic Radiotherapy for Brain Metastases From Lung Cancer

It is well known that bevacizumab is effective against radiation necrosis in the brain (hereafter referred to as brain necrosis). Herein, we report a case of brain necrosis in a patient treated with a regimen that included ramucirumab, an anti-vascular endothelial growth factor (VEGF) inhibitor. A woman in her 40s presented with five brain metastases from lung adenocarcinoma at the initial diagnosis. Each metastasis was treated with stereotactic radiotherapy. Subsequent magnetic resonance imaging showed increased oedema surrounding the lesion in the left frontal lobe, leading to a diagnosis of radiation-induced brain necrosis. Docetaxel + ramucirumab was chosen for third-line chemotherapy. During treatment, perioperative brain necrotic oedema diminished. Furthermore, anti-VEGF inhibitor regimens should be considered for reducing oedema associated with radiation necrosis of the brain, as they can be utilized alongside chemotherapy for the primary tumor.