贝伐珠单抗治疗难治性瘤周脑水肿的近期疗效观察

Clinical efficacy of bevacizumab for the treatment of serious peritumorous brain edema

目的：观察贝伐珠单抗（bevacizumab，BEV）治疗难治性瘤周脑水肿的近期疗效。方法：分析2014年4月至2016年4月三峡大学肿瘤防治中心收治的16例行BEV治疗的难治性瘤周脑水肿患者的临床资料，其中肺癌脑转移13例、乳腺癌脑转移2例、复发性胶质母细胞1例，所有患者对糖皮质激素、渗透性脱水剂等常规治疗不敏感。BEV每次使用剂量为5 mg/kg，每3～4周重复，至少接受1次以上BEV治疗；MRI测量治疗前、首次治疗后1个月、首次治疗后2个月瘤周水肿及瘤体体积并计算水肿指数；记录患者治疗前后临床症状，功能状态评分（KPS）及不良反应；采用t检验及最小显著性差异法比较组间差异。结果：16例患者治疗后临床症状均得到改善，KPS评分显著提高（P〈0.001）；全组患者瘤周水肿体积及肿瘤体积较治疗前明显缩小（P〈0.05），水肿指数较治疗前显著降低，且未出现严重不良反应。结论：BEV可有效控制脑恶性肿瘤瘤周脑水肿，为难治性严重脑水肿患者改善生存质量争取治疗机会。

Objective：To investigate the efficacy of bevacizumab on the treatment of serious peritumorous brain edema. Methods：A total of 16 patients with malignant brain tumors and serious peritumorous brain edema, （13 cases of lung cancer, 2 cases of breast can-cer, and 1 case of recurrent glioblastoma） were analyzed. Treatment with glucocorticoids, osmotic dehydration, and other convention-al approaches were not effective for these patients. Bevacizumab was administered at a dose of 5 mg/kg at least once every three or four weeks. The Karnofsky performance score （KPS） and the changes in cerebral edema symptoms, such as cerebral edema volume, tu-mor volume, edema index （EI）, and changes in magnetic resonance imaging （MRI） were compared before and after treatment. The t-test and least-significant difference method were used to compare treatment groups. Results：All bevacizumab-treated patients had re-duced symptoms. The KPS after treatment was significantly higher than that before treatment （P〈0.001）. The cerebral edema vol-umes, tumor volumes, and EI of 16 patients were significantly decreased （P〈0.05）. Bevacizumab caused mild clinical side effects. Con-clusion：Preliminary results showed that treatment of serious peritumorous brain edema with bevacizumab was safe and effective.