贝伐单抗联合全脑放疗治疗多发脑转移癌疗效分析与预防放射性脑坏死临床研究

目的探讨贝伐单抗联合全脑放疗对有症状的多发脑转移癌的临床疗效并比较放疗前和放疗后6个月颅脑病灶以及水肿、神经认知功能的变化。方法收集2014年10月～2019年1月多发脑转移癌患者,将40例有症状的多发脑转移癌(3个转移灶)患者随机分为两组,实验组和对照组各20例,实验组予以贝伐单抗联合全脑放疗,全脑放疗剂量为DT 40 Gy/20 F,自放疗第1天开始给予贝伐单抗5 mg/kg每2周1次直至病情进展;对照组给予全脑放疗,全脑放疗剂量为DT 40 Gy/20 F。比较两组之间脑转移瘤的控制有效率、神经认知功能、无进展生存期(Progression free survival, PFS)以及放射性脑坏死发生率的差异。结果实验组和对照组疾病控制有效率分别是95.00%和80.00%(P0.05)。实验组治疗后认知功能评分较对照组有改善,且有显著统计学差异(P0.05),两组之间PFS实验组10.2个月,而对照组7.0个月,两组之间有显著统计学差异,而放射性脑坏死在两组之间无统计学差异(P0.05)。结论贝伐单抗联合全脑放疗治疗多发脑转移癌可以提高脑转移瘤有效率,并改善患者的PFS以及神经认知功能。

Efficacy of bevacizumab combined with whole brain radiotherapy in treatment of multiple brain metastatic cancer and prevention of brain radiation necrosis

Objective To evaluate the clinical efficacy of bevacizumab combined with whole brain radiotherapy in treatment of symptomatic multiple brain metastatic cancer,compare the changes of brain lesions,edema and neurocognitive function before and after radiotherapy.Methods Patients with multiple brain metastatic cancer who were treated from October 2014 to January 2019 were enrolled.Forty patients with symptomatic multiple brain metastatic cancer(>3 metastases) were randomly divided into two groups,with 20 patients in the experimental group and 20 patients in the control group.Whole brain radiotherapy combined with bevacizumab was given to the experimental group.The dose of whole brain radiotherapy was DT 40 Gy/20 F.Bevacizumab was administered at a dose of 5 mg/kg once every 2 weeks from the first day of radiotherapy until disease progression.Whole brain radiotherapy was given to the control group.The dose of whole brain radiotherapy was DT 40 Gy/20 F.The differences of response rate of brain metastatic cancer,neurocognitive function,progression-free survival (PFS) and incidence rate of brain radiation necrosis were compared between the two groups.Results The response rates of brain metastatic cancer in the experimental group and the control group were 95.00% and 80.00%,respectively(P<0.05).The neurocognitive function scores of the experimental group were improved compared with the control group,with statistically significant difference(P<0.05).The PFS of the experimental group was 10.2 months,while the control group was 7.0 months.There was statistically significant difference between the two groups in terms of PFS.There was no statistically significant difference of brain radiation necrosis between the two groups (P>0.05).Conclusion Bevacizumab combined with whole brain radiotherapy for the treatment of multiple brain metastatic cancer can increase the response rate of brain metastatic cancer and improve PFS and neurocognitive function in patients.