贝伐单抗治疗放射性脑坏死初步疗效分析

目的 评估贝伐单抗治疗放射性脑坏死(CRN)的初步临床疗效。方法 回顾分析经类固醇激素及甘露醇治疗仍进展的放射性脑坏死患者 19例,共计22处病灶。其中5处病灶经过病理证实,其他病灶均同时满足以下各项影像学证据:①CT或MRI增强病灶表现为失张力强化且伴有明显水肿;②CT或MRI增强病灶均为低灌注;③MRS提示强化区域的Cho峰降低;④PET示强化区域的FDG摄取明显减低。所有患者均给予贝伐单抗5 mg/kg,每14 d重复1次,治疗 2~6个周期。每周期治疗前均行MRI检查,比较治疗前后T₁WI相增强病灶变化情况及T₂WI相病灶水肿情况。记录患者临床症状、KPS评分改变情况及药物不良反应,治疗前后比较行配对t检验。结果 19例患者均安全完成治疗,未见严重不良反应。自第2周期治疗结束患者临床症状明显改善,KPS评分平均提高26.8分。MRI的T₁WI增强相可见强化区域病灶较治疗前平均缩小54.8%(P=0.000),MRI的 T₂WI相可见水肿区域较治疗前平均缩小80.7%(P=0.000)。平均随访时间 3~12个月(平均值5.6个月),11例病情改善维持,4例复发,4例因肿瘤进展死亡。结论 初步证实贝伐单抗能明显改善CRN的临床症状并提高生活质量。

Preliminary efficacy of bevacizumab for cerebral radiation necrosis

Objective To evaluate the preliminary clinical efficacy of bevacizumab for cerebral radiation necrosis (CRN). Methods Nineteen patients with CRN for whom the treatment with steroids and mannitol failed were retrospectively analyzed with a total of 22 lesions. Except for 5 lesions confirmed by pathological evidence, all lesions were confirmed by the following imaging evidence:1. computed tomography (CT)-or magnetic resonance imaging (MRI)-enhanced lesions showed loss of tension and were accompanied by substantial edema;2. CT-or MRI-enhanced lesions had a low perfusion pressure;3. magnetic resonance spectroscopy indicated that the enhanced areas had a decreased choline peak;4. positron emission tomography showed that the fluorodeoxyglucose uptake was substantially reduced in the enhanced areas. All patients were given 5 mg/kg bevacizumab at an interval of 14 days for 2-6 cycles. MRI examination was performed in each cycle before treatment, and the enhanced lesions on T₁-weighted images (T₁WI) and edema on T₂-weighted images (T₂WI) were compared before and after treatment. The clinical symptoms, Karnofsky Performance Status (KPS), and adverse reactions in all patients were evaluated. Comparison before and after treatment was performed by paired t test. Results All 19 patients completed the treatment successfully and there were no severe adverse reactions. The clinical symptoms of patients were substantially improved after the second cycle of treatment, and the KPS score increased by 26.8 on average. The visible volume of enhanced lesions on MRI T₁WI was significantly reduced by 54.8% after treatment (P=0.000), while the visible volume of edema on MRI T₂WI was reduced by 80.7% after treatment (P=0.000). The follow-up time ranged from 3 to 12 months with a mean value of 5.6 months. Eleven patients kept clinical improvement in CRN, four patients had recurrence, and four patients died from tumor progression. Conclusions Bevacizumab is preliminarily confirmed to substantially improve the clinical symptoms and quality of life in patients with CRN.