贝伐珠单抗治疗难治性脑转移瘤瘤周水肿的临床观察

Clinical observation of bevacizumab in the treatment of peritumoral brain edema in refractory brain metastases

目的观察贝伐珠单抗治疗难治性脑转移瘤瘤周水肿的疗效。方法分析20例难治性脑转移瘤瘤周水肿患者的临床资料,所有患者均接受甘露醇联合地塞米松常规剂量治疗5 d以上,临床症状无明显缓解。根据5 mg/kg的标准计算每次贝伐珠单抗的使用剂量,每2周重复一次。所有患者至少接受贝伐珠单抗治疗1次,治疗后3 d停止常规脱水及激素治疗。使用头部MRI增强扫描来评估瘤周水肿的程度,记录患者使用贝伐珠单抗前后的瘤周水肿程度、KPS评分以及使用贝伐珠单抗后的不良反应。结果治疗后16例患者颅压增高的临床症状明显改善,4例患者症状缓解不明显。全组患者治疗后的KPS评分高于治疗前,治疗后1个月和2个月的水肿指数均低于治疗前,差异均有统计学意义(P<0.05)。治疗过程中无严重不良反应发生。结论贝伐珠单抗治疗难治性脑转移瘤瘤周水肿有良好的效果,能改善患者的生活质量,但目前研究病例数较少,尚需多中心大规模的临床研究进一步论证。

Objective To observe the effect of bevacizumab in the treatment of peritumoral brain edema in refractory brain metastases. Method Twenty patients with refractory brain metastases combined with peritumoral brain edema were included in the analysis. All patients received mannitol combined with dexamethasone at conventional dose for more than 5 days, but the clinical symptoms were not relieved. The dose of bevacizumab was calculated according to the standard of 5 mg/kg and repeated every 2 weeks. All patients were treated with bevacizumab at least once, and stopped using conventional dehydration and hormone therapy after bevacizumab treatment for 3 days. The peritumoral brain edema volume was assessed using magnetic resonance imaging（MRI） with T2 enhancement, the severity of peritumoral brain edema and the KPS score before and after bevacizumab, as well as the adverse reactions after treatment with bevacizumab were recorded. Result After the treatment of bevacizumab, the clinical symptom of increased intracranial pressure was significantly relieved in 16 cases, but not in 4 cases. After treatment, the KPS score was significantly higher than that before treatment, and the edema indexes in 1 and 2 months after treatment were significantly lower than that before treatment（P〈0.05）. No serious adverse reactions occurred during the course of treatment. Conclusion Bevacizumab is clinically effective in the treatment of peritumoral brain edema in refractory brain metastases, which can improve the quality of life of patients. However, the number of cases included in the study is limited, and further large-scale clinical research is warranted.