胶质母细胞瘤难治性放化疗脑水肿贝伐珠单抗联合替莫唑胺治疗临床观察

Clinical observation of bevacizumab combined with temozolomide in the treatment of glioblastoma patients with intractable brain edema after radiotherapy and chemotherapy

目的 胶质母细胞瘤(glioblastoma multiforme,GBM)放化疗中出现难治性脑水肿是影响患者治疗效果和预后的重要因素,本研究旨在观察贝伐珠单抗(bevacizumab,BEV)联合替莫唑胺(temozolomide,TMZ)治疗难治性脑水肿的疗效和安全性.方法 回顾性分析2014-02-03-2017-06-17华中科技大学同济医学院附属同济医院收治的GBM难治性放化疗脑水肿患者33例.所有患者在TMZ化疗方案的基础上,给予BEV 3 mg/(kg·d),静脉滴入,每2周1次,平均(4.3±1.0)个周期.采用头部磁共振-T2加权像评估脑水肿级别,格拉斯哥昏迷评分(Glasgow coma scale,GCS)及卡氏功能状态评分(Karnofsky performance score,KPS)评估脑水肿治疗效果.采用非参数检验比较治疗前后GCS及KPS评分.结果 BEV联合TMZ脑水肿影像学缓解率为81.8%(27/33),症状缓解率为87.9%(29/33).治疗后GCS评分(14.7±0.7)高于治疗前(13.6±2.2),Z=-2.77,P<0.01,差异有统计学意义;治疗后KPS评分(66.4±4.9)%高于治疗前(56.4±7.0)%,Z=-4.03,P<0.001,差异有统计学意义.联合用药不良反应发生率为39.4%,其中3级以上高血压发生率6.06%,无其他3级以上不良反应.结论 联合BEV和TMZ治疗GBM放化疗难治性脑积水能够减轻脑水肿,改善症状,提高患者GCS及KPS评分.

OBJECTIVE The occurrence of refractory brain edema in glioblastoma multiforme(GBM) radiotherapy and chemotherapy is an important factor affecting the treatment effect and prognosis of patients. This study aimed to ob-serve the efficacy and safety of bevacizumab(BEV) combined with temozolomide(TMZ) in the treatment of refractory brain edema. METHODS A retrospective analysis was performed in 33 GBM patients with refractory brain edema during radiotherapy and chemotherapy in Tongji Hospital,Tongji Medical College of Huazhong University of Science and Tech-nology from Feb 3rd,2014 to June 17th,2017. On the basis of TMZ chemotherapy regimen,all patients were given intrave-nous drip of BEV 3 mg/(kg·d),once every two weeks. The average courses of treatment were 4. 3 ± 1. 0. The grade of brain edema was examined by MRI-T2 imaging,and the effect of brain edema release was evaluated by Glasgow coma scale (GCS) and Karnofsky performance score(KPS). The GCS and KPS scores before and after treatment were compared by non-parametric test. RESULTS The imaging remission rate of BEV combined with TMZ was 81. 8%(27/33) and the symptom remission rate was 87. 9 To (29/33). After treatment, the GCS score (14. 7 ± 0. 7) was higher than that before treatment (13. 6 ± 2. 2), Z=- 2. 77, P<0. 01. The KPS score (66. 4 ± 4. 9)% was higher than that before treatment (56. 4 ± 7. 0)%,Z=-4. 03 ,P<40. 001. The incidence of adverse reactions was 39. 4%. The incidence of hypertension a- bove grade 3 was 6. 06%. There was no other adverse reactions above grade 3. CONCLUSIONS The combination of BEV and TMZ in the treatment of refractory hydrocephalus caused by GBM radiotherapy and chemotherapy can reduce cerebral edema, improve symptoms and improve GCS and KPS scores of patients.