Department of Radiation Oncology, Huashan Hospital, Fudan University, Shanghai, China.
Eur J Med Res. 2012 Aug 23;17(1):25. doi: 10.1186/2047-783X-17-25.
Bevacizumab has been suggested as a new treatment modality for cerebral radiation necrosis due to its ability to block the effects of vascular endothelial growth factor (VEGF) in leakage-prone capillaries, though its use still remains controversial in clinical practice.
The use of bevacizumab in 17 patients with symptomatic cerebral radiation necrosis poorly controlled with dexamethasone steroid treatments was examined between March 2010 and January 2012. Bevacizumab therapy was administered for a minimum of two cycles (7.5 mg/kg, at two-week interval) with a median of four bevacizumab injections. Changes in bi-dimensional measurements of the largest radiation necrosis lesions were observed by gadolinium-enhanced and T2-weighted magnetic resonance imaging (MRI). Additionally, dexamethasone dosage, Karnofsky performance status (KPS), adverse event occurrence and associated clinical outcomes were recorded for each patient.
MRI analysis revealed that the average reduction was 54.9% and 48.4% in post-gadolinium and T2-weighted sequence analysis, respectively. Significant clinical neurological improvements were expressed in 10 patients according to KPS values. Dexamethasone reduction was achieved four weeks after initiation of bevacizumab in all patients, with four patients successfully discontinuing dexamethasone treatment. Mild to moderate bevacizumab-related adverse events, such as fatigue, proteinuria and hypertension were observed in three patients. Upon follow-up at 4 to 12 months, 10 patients showed clinical improvement, and 7 patient deaths occurred from tumor progression (5 patients), recurrent necrosis (1 patient), and uncontrolled necrosis-induced edema (1 patient).
These findings suggest bevacizumab as a promising treatment for cerebral radiation necrosis induced by common radiation therapies, including external beam radiotherapy (EBRT), stereotactic radiosurgery (SRS), and fractionated stereotactic radiotherapy (FSRT).
贝伐单抗因其能够阻断血管内皮生长因子（VEGF）在易渗漏的毛细血管中的作用，被认为是治疗放射性脑坏死的一种新的治疗方法。然而，其在临床实践中的应用仍存在争议。
在 2010 年 3 月至 2012 年 1 月期间，对 17 例因接受激素（地塞米松）治疗而症状性放射性脑坏死控制不佳的患者使用贝伐单抗进行了研究。贝伐单抗治疗至少进行两个周期（7.5mg/kg，间隔两周），中位数为 4 次贝伐单抗注射。通过钆增强和 T2 加权磁共振成像（MRI）观察最大放射性坏死病变的二维测量变化。此外，记录了每位患者的地塞米松剂量、卡诺夫斯基表现状态（KPS）、不良事件发生情况和相关临床结果。
MRI 分析显示，在钆增强和 T2 加权序列分析中，平均分别减少了 54.9%和 48.4%。根据 KPS 值，10 例患者表现出显著的临床神经改善。所有患者在开始使用贝伐单抗后 4 周内均实现了地塞米松的减少，其中 4 例患者成功停用了地塞米松治疗。3 例患者出现了轻度至中度与贝伐单抗相关的不良事件，如疲劳、蛋白尿和高血压。在 4 至 12 个月的随访中，10 例患者表现出临床改善，7 例患者死亡，其中 5 例因肿瘤进展、1 例因复发性坏死、1 例因无法控制的坏死性水肿导致。
这些发现表明，贝伐单抗是一种有前途的治疗方法，可用于治疗常见放射治疗引起的放射性脑坏死，包括外照射放疗（EBRT）、立体定向放射外科（SRS）和分次立体定向放射治疗（FSRT）。
