贝伐单抗维持治疗脑转移瘤疗效与安全性分析(1)
摘要：目的 评估贝伐单抗治疗全脑放疗后复发或进展脑转移瘤的临床疗效。方法 回顾分析放疗后进展或复发脑转移瘤患者21例，共计28处病灶。患者有原发肿瘤病史且均取得病理，病灶均同时满足以下各项影像学证据：CT或MRI增强病灶表现为灶内强化且伴有明显水肿影；所有患者均给予贝伐单抗5 mg/kg，每14 d重复1次，治疗4～8个周期。每4周期治疗后第5周期治疗前均行MRI检查，比较治疗前后T1WI相增强病灶大小变化及T1WI相病灶水肿变化。记录患者治疗前、后临床症状、kps评分改变情况，治疗前、后病灶大小、水肿变化以及KPS评分行t检验。结果 21例患者均安全完成治疗，未见明显严重不良反应。自第1周期治疗结束患者临床症状明显改善，4周期后kps评分平均提高13.8分。MRI T1WI增强相可见强化区域病灶较治疗前平均缩小54.8%，(P=0.001)，MRI T2WI相可见水肿区域较治疗前平均缩小80.7%(P=0.004)。结论 初步证实贝伐单抗能控制脑转移瘤，明显减轻颅内水肿，并改善脑转移瘤的临床症状。
关键词：贝伐单抗；脑转移瘤；颅脑水肿；全脑放疗
, 百拇医药
Abstract：Objective To evaluate the clinical effect of bevacizumab for recurrence or progression brain metastases after whole brain radiotherapy .Methods Retrospective analysis of 20 cases of recurrence or progession brain metastases after radiotherapy， a total of 28 lesions. Patients had primary tumor history and pathology were obtained， the lesions were also satisfy the following the image evidence： CT or MRI enhanced lesions showed foci in the strengthening and accompanied by edema； All patients were given bevacizumab 5mg / kg， every 14 days repeated 1 time for 8 cycles. After the forth cycles of treatment， MRI was examined before and after treatment， and the changes of T1WI phase and edema of T1WI phase were compared before and after treatment. The clinical symptoms， KPS score ， the size of the lesion， edema were record respectively before and after treatment. Comarision before and afer treatment was perofomed by paried t test. Results All the 20 patients receive treatment successfully， and no serious adverse reactions were found. The clinical symptoms of the patients were significantly improved after first cycles of treatment， and the KPS score increased by 13.8 points on average after 4 cycles. The regional lesions of T1WI MRI enhanced phase were smaller average 54.8% than before treatment， (P= 0.001)， T2WI MRI edema region were smaller average 80.7% compared with the before treatment (P= 0.004).Conclusion Bevacizumab is preliminary confirmed to control the brain metastatic tumor， alleviate cerebral edema， and improve clinical symptoms of brain metastases.
, 百拇医药
Key words：Bevacizumab； Brain metastases； Encephaledema；Whole brain radiotherapy
恶性肿瘤脑转移是肿瘤常见的并发症，约20%～40%的癌症患者发生脑转移，尤其是好发生于肺癌和乳腺癌患者[1]。发生脑转移患者预后极差，自然生存时间1～3个月，全脑放疗(whole brain therapy，WBT)中位生存时间延长至3～6个月。故50年来全脑放疗一直是脑转移癌的标准治疗手段。但是全脑放疗有效率60%～80%，多数肿瘤短暂缓解后再次进展，中位生存期4～6个月，1年生存率14%～20%[2-3]。且再次复发后患者生活质量受到严重影响，治疗手段有限，常规再次放疗易造成正常神经组织坏死，预后极差。VEGF是目前发现的最重要的促进肿瘤血管生成的因子。在肿瘤的生长、复发、转移以及改变血脑屏障的通透性有重要的作用[4-6]。文献报道，晚期肿瘤患者外周血VEGF水平明显高于早期肺癌，VEGF可刺激肿瘤组织中微血管的生成，从而促进血管通透性增加肿瘤的进展与转移。肿瘤患者中高浓度的VEGF往往有更差的预后[7]。贝伐单抗是VEGF的单克隆抗体，可阻断VEGF的生物学的作用，并可透过血脑屏障，從而控制肿瘤，同时减轻颅内水肿作用改善患者脑转移症状，延长生存时间[8-12]。本研究试从分析贝伐珠单抗治疗放疗后脑转移瘤进展或者复发患者疗效。, 百拇医药(石大友 廖立潇 熊超)
关键词：贝伐单抗；脑转移瘤；颅脑水肿；全脑放疗
, 百拇医药
Abstract：Objective To evaluate the clinical effect of bevacizumab for recurrence or progression brain metastases after whole brain radiotherapy .Methods Retrospective analysis of 20 cases of recurrence or progession brain metastases after radiotherapy， a total of 28 lesions. Patients had primary tumor history and pathology were obtained， the lesions were also satisfy the following the image evidence： CT or MRI enhanced lesions showed foci in the strengthening and accompanied by edema； All patients were given bevacizumab 5mg / kg， every 14 days repeated 1 time for 8 cycles. After the forth cycles of treatment， MRI was examined before and after treatment， and the changes of T1WI phase and edema of T1WI phase were compared before and after treatment. The clinical symptoms， KPS score ， the size of the lesion， edema were record respectively before and after treatment. Comarision before and afer treatment was perofomed by paried t test. Results All the 20 patients receive treatment successfully， and no serious adverse reactions were found. The clinical symptoms of the patients were significantly improved after first cycles of treatment， and the KPS score increased by 13.8 points on average after 4 cycles. The regional lesions of T1WI MRI enhanced phase were smaller average 54.8% than before treatment， (P= 0.001)， T2WI MRI edema region were smaller average 80.7% compared with the before treatment (P= 0.004).Conclusion Bevacizumab is preliminary confirmed to control the brain metastatic tumor， alleviate cerebral edema， and improve clinical symptoms of brain metastases.
, 百拇医药
Key words：Bevacizumab； Brain metastases； Encephaledema；Whole brain radiotherapy
恶性肿瘤脑转移是肿瘤常见的并发症，约20%～40%的癌症患者发生脑转移，尤其是好发生于肺癌和乳腺癌患者[1]。发生脑转移患者预后极差，自然生存时间1～3个月，全脑放疗(whole brain therapy，WBT)中位生存时间延长至3～6个月。故50年来全脑放疗一直是脑转移癌的标准治疗手段。但是全脑放疗有效率60%～80%，多数肿瘤短暂缓解后再次进展，中位生存期4～6个月，1年生存率14%～20%[2-3]。且再次复发后患者生活质量受到严重影响，治疗手段有限，常规再次放疗易造成正常神经组织坏死，预后极差。VEGF是目前发现的最重要的促进肿瘤血管生成的因子。在肿瘤的生长、复发、转移以及改变血脑屏障的通透性有重要的作用[4-6]。文献报道，晚期肿瘤患者外周血VEGF水平明显高于早期肺癌，VEGF可刺激肿瘤组织中微血管的生成，从而促进血管通透性增加肿瘤的进展与转移。肿瘤患者中高浓度的VEGF往往有更差的预后[7]。贝伐单抗是VEGF的单克隆抗体，可阻断VEGF的生物学的作用，并可透过血脑屏障，從而控制肿瘤，同时减轻颅内水肿作用改善患者脑转移症状，延长生存时间[8-12]。本研究试从分析贝伐珠单抗治疗放疗后脑转移瘤进展或者复发患者疗效。, 百拇医药(石大友 廖立潇 熊超)