Bevacizumab treatment of symptomatic pseudoprogression after boron neutron capture therapy for recurrent malignant gliomas. Report of 2 cases
Bevacizumab treatment of symptomatic pseudoprogression after boron neutron capture therapy for recurrent malignant gliomas. Report of 2 cases
复制标题
DOI：
10.1093/neuonc/not020
复制
发表时间：
2013-06-01
期刊：
影响因子：
15.9
通讯作者：
Ono, Koji
中科院分区：
文献类型：
--
作者：
Miyatake, Shin-Ichi;Furuse, Motomasa;Ono, Koji
贝伐单抗是一种抗血管内皮生长因子抗体，已用于治疗放射性坏死。然而，到目前为止，还没有关于它用于治疗症状性假性进展的明确报告。在此，我们报告2例复发性恶性胶质瘤采用硼中子俘获治疗(BNCT)后，贝伐单抗成功治疗症状性假性进展。两例患者均在病情恶化时给予贝伐单抗治疗，1例为复发性多形性胶质母细胞瘤，2例为复发性间变性少星形细胞瘤。这两个病例都在标准的放化疗后复发，并被转至我们的BNCT研究所，这是一种肿瘤选择性粒子放射治疗。就在中子照射之前，每个病例都进行了带有氨基酸示踪剂的PET检查，以确认肿瘤复发。两例患者分别在BNCT后4个月和2个月出现症状恶化和MRI恶化。对于第一种情况，进行了第二次正电子发射计算机断层扫描，以确认示踪剂摄取没有增加。我们诊断两例均为症状性假性进展，开始静脉注射贝伐单抗5 mg/kg，每两周一次，共6周期。这两个病例对此反应良好，在神经影像和临床症状方面显示出迅速和显著的改善。BNCT后8个月未观察到肿瘤进展。贝伐单抗对BNCT后症状假性进展有显著效果。BNCT联合贝伐单抗可延长复发恶性胶质瘤患者的生存期。
Bevacizumab, an antivascular endothelial growth factor antibody, has been used for the treatment of radiation necrosis. Thus far, however, there has been no definitive report on its use for the treatment of symptomatic pseudoprogression. Here we report 2 cases of successful treatment with bevacizumab for symptomatic pseudoprogression after boron neutron capture therapy (BNCT) was applied for recurrent malignant gliomas.Two recurrent malignant gliomas received BNCT. Both cases were treated with intravenous administration of bevacizumab at the deterioration that seemed to be symptomatic pseudoprogression.The first case was recurrent glioblastoma multiforme and the second was recurrent anaplastic oligoastrocytoma. Both cases recurred after standard chemoradiotherapy and were referred to our institute for BNCT, which is tumor-selective particle radiation. Just prior to neutron irradiation, PET with an amino acid tracer was applied in each case to confirm tumor recurrence. Both cases showed deterioration in symptoms, as well as on MRI, at intervals of 4 months and 2 months, respectively, after BNCT. For the first case, a second PET was applied in order to confirm no increase in tracer uptake. We diagnosed both cases as symptomatic pseudoprogression and started the intravenous administration of 5 mg/kg bevacizumab biweekly with 6 cycles. Both cases responded well to this, showing rapid and dramatic improvement in neuroimaging and clinical symptoms. No tumor progression was observed 8 months after BNCT.Bevacizumab showed marked effects on symptomatic pseudoprogression after BNCT. BNCT combined with bevacizumab may prolong the survival of patients with recurrent malignant gliomas.