Bevacizumab for refractory adverse radiation effects after stereotactic radiosurgery
Bevacizumab for refractory adverse radiation effects after stereotactic radiosurgery
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DOI：
10.1007/s11060-013-1214-3
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发表时间：
2013-11-01
影响因子：
3.9
通讯作者：
Kondziolka, Douglas
中科院分区：
文献类型：
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作者：
Deibert, Christopher P.;Ahluwalia, Manmeet S.;Kondziolka, Douglas
回顾性评价贝伐单抗用于治疗立体定向放射外科手术后难治性放射不良反应（ARE）的临床获益和影像学反应。29例脑肿瘤或血管畸形患者在SRS后出现ARE的临床和/或影像学证据，并接受了贝伐单抗治疗。SRS后中位16个月，患者在平均5.7周内接受平均剂量7.4 mg/kg。比较贝伐珠单抗给药前后的初始诊断、SRS剂量、贝伐珠单抗治疗方案、磁共振成像T2/FLAIR和T1顺磁对比增强水肿体积。百分之九十（18/20）具有临床症状的ARE患者在贝伐珠单抗治疗后神经功能有所改善。26例患者的T2/FLAIR体积减少了62%，磁共振成像静脉造影增强体积减少了50%。2例患者显示T2/FLAIR和对比增强体积的进展。1例患者Gd增强后进展，但T2/FLAIR体积消退。20例患者中有11例在停止治疗后症状复发。经历增强恢复的患者在SRS期间接受较低的边缘剂量。我们的经验提供了额外的证据，贝伐单抗减少了ARE患者的症状和反应性影像学变化。SRS后，对初始皮质类固醇或其他药物无反应的难治性ARE可能从贝伐单抗试验中获益。治疗的必要持续时间和最佳剂量尚不清楚，这为进行前瞻性试验提供了进一步的动力。
To retrospectively evaluate the clinical benefit and imaging response of bevacizumab when used to treat refractory adverse radiation effects (ARE) after stereotactic radiosurgery. Twenty-nine patients with brain tumors or vascular malformations developed clinical and/or imaging evidence of ARE after SRS and were treated using bevacizumab. Patients received an average dose of 7.4 mg/kg over a mean of 5.7 weeks at a median of 16 months following SRS. Initial diagnosis, SRS dose, bevacizumab treatment protocols, magnetic resonance imaging T2/FLAIR and T1 paramagnetic contrast enhanced edema volumes were compared before and after bevacizumab administration. Ninety percent (18/20) with clinically symptomatic ARE had neurological improvement after bevacizumab therapy. Twenty-six patients had a decrease of 62 % of T2/FLAIR volumes and a 50 % decrease in magnetic resonance imaging intravenous contrast enhancement volumes. Two patients showed progression of the T2/FLAIR and contrast enhancement volumes. One patient had progression of post-Gd-enhancement but regression of T2/FLAIR volume. Symptoms recurred in 11 of the 20 patients after discontinuing therapy. Patients who experienced a return of enhancement received a lower marginal dose during SRS. Our experience provides additional evidence that bevacizumab reduces both symptoms and reactive imaging changes in patients with ARE. After SRS, refractory ARE unresponsive to initial corticosteroids or other agents may benefit from a bevacizumab trial. The necessary duration and optimum dose of therapy is unknown and provides a further impetus to conduct a prospective trial.