贝伐珠单抗治疗放射性脑损伤的疗效研究

目的 评估贝伐珠单抗单药治疗放射性脑损伤的疗效及安全性。方法 对23例确诊放射性脑损伤并接受贝伐珠单抗单药治疗的患者进行回顾性分析。贝伐珠单抗治疗方案为静脉滴注（每次5 mg/kg，每两周1次，共4次）。分别在给药前及疗程结束后2周行头颅MRI检查、LENT-SOMA量表和MoCA量表评分，并记录治疗期间的不良事件。结果 2例患者在第1个疗程时出现鼻衄，随即终止治疗。其余21例患者在完成相应疗程的贝伐珠单抗治疗后临床症状明显改善，与基线水平相比，治疗后MRI T2相水肿体积明显缩小[平均缩小（53.9±22.13）%，Z=-5.645，P<0.05]。治疗后MOCA评分较治疗前增高（t=3.166，P<0.05），其中1例患者虽然在完成两个疗程后MRI上表现为病灶范围轻度增加，但是在4次治疗结束后病情明显改善。在所有完成4次治疗的患者中，1例患者出现皮疹，2例患者出现高血压，另有1例有轻度颅内出血，无3到5级不良反应事件。结论 贝伐珠单抗单药治疗放射性脑损伤有较好的疗效和安全性。

Efficacy of Bevacizumab monotherapy on radiation-induced brian necrosis

Objective To explore the effects and safety of bevacizumab monotherapy on radiation-induced brain necrosis in patients with head and neck cancer. Methods Twenty-three patients with radiation-induced brain necrosis received intravenous injection of bevacizumab 5 mg/kg every 2 weeks for 4 cycles. Before and 2 weeks after the treatment LENT/SOMA scoring system, Montreal Cognitive Assessment (MoCA), and MRI were used to evaluate the scores of subjective and objective items, cognitive scores, and the extent of edema. Adverse effects were observed. Results Two patients suffered from grade 2 rhinorrhagia after the first dose and had to give up the therapy. Twenty-one patients received the full dose of bevacizumab and showed improvement in clinical signs and symptoms. The MoCA score after treatment was significantly higher than that before treatment (t=3.166,P<0. 05). MRI T2-weighted image showed that the volume of brain edema was decreased by (53.9±22.13)% on average (Z=-5.645,P<0.05). One patient showed mild exacerbation of the extent of focus on MRI after the second cycle therapy but still showed significant improvement at the end of four cycles. Of the 21 cases that successfully finished the whole treatment, one suffered from grade 2 rash and one had mild intracranial hemorrhage, however, no grade 3 to 5 adverse reactions were observed. Conclusions Bevacizumab monotherapy may have a rapid and safe therapeutic effect on radiation necrosis.