脑转移瘤单次与分次立体定向放射外科后放射性脑坏死发生时间及贝伐珠单抗疗效观察

目的观察脑转移瘤单次与分次行立体定向放射外科(SRS)后放射性脑坏死(CRN)发生时间及贝伐珠单抗的疗效.方法回顾性分析20例CRN患者的临床资料.按SRS治疗方式分为2组,其中单次SRS组13例,分次完成SRS组7例,统计各组CRN情况,应用贝伐珠单抗5 mg/kg,21 d重复1次,2个周期.比较两组患者卡氏(KPS)评分改变、头颅磁共振T1增强病灶变化及T2 FLAIR水肿变化.结果分次SRS组较单次SRS组产生CRN较迟,20例CRN患者均完成至少2个周期的治疗,治疗2个周期后,两组患者KPS评分、头颅磁共振T1增强病灶变化及T2 FLAIR病灶水肿变化均有明显改善,分次组与单次组KPS评分、CRN病灶平均体积及病灶水肿区体积减小程度比较差异无统计学意义(P>0.05).结论分次SRS较单次SRS产生CRN较迟,但贝伐珠单抗在脑转移瘤单次与分次行SRS后CRN中的疗效相似.

Objective To evaluate the occurrence time of cerebral radiation necrosis(CRN)and the efficacy of bevacizumab after single and fractionated stereotactic radio surgery(SRS)for brain metastases.Methods A total of 20 patients with CRN were analyzed retrospectively.All patients were divided into two groups according to the SRS treatment method,including 13 cases in the single SRS group and 7 cases in the fractionated SRS group.The number and occurrence time of patient with CRN in each group was counted.Bevacizumab 5 mg/kg was applied and repeated once in 21 days for 2 cycles.The changes of KPS score,T1 enhanced lesions and edema in T2 FLAIR was compared between the two groups.Results CRN occurred later in the fractionated SRS group than in the single SRS group.All 20 patients with CRN completed at least 2 cycles of treatment.After 2 cycles of treatment,the KPS score and changes of T1 enhanced lesions of cranial magnetic resonance and edema in the two groups were significantly improved.There was no significant difference in KPS score,average volume of CRN lesions and volume reduction of edema area between the fractionated group and the single group(P>0.05).Conclusion CRN occurs later in the fractionated SRS group than in the single SRS group.The efficacy of bevacizumab is similar in patients with CRN regardless whether they receive single or fractionated SRS.