Delishaj Durim, Ursino Stefano, Pasqualetti Francesco, Cristaudo Agostino, Cosottini Mirco, Fabrini Maria Grazia, Paiar Fabiola
Department of Radiotherapy, University Hospital of Pisa, Italy.
Neuroradiology Unit, University Hospital of Pisa, Italy.
J Clin Med Res. 2017 Apr;9(4):273-280. doi: 10.14740/jocmr2936e. Epub 2017 Feb 21.
Radiation necrosis (RN) of brain tissue is a serious late complication of brain irradiation and recently bevacizumab has been suggested as treatment option of RN. There is a lack of data in the literature regarding the effectiveness of bevacizumab for the treatment of RN. The purpose of this review was to perform a comprehensive analysis of all reported cases using bevacizumab for the treatment of brain RN. In September 2016, we performed a comprehensive literature search of the following electronic databases: PubMed, Web of Science, Scopus and Cochrane Library. The research for the review was conducted using a combination of the keywords "radiation necrosis", "radiotherapy" and "bevacizumab" alongside the fields comprising article title, abstract and keywords. Randomized trials, non-randomized trials, prospective studies, retrospective studies and single case reports were included in the review. Our research generated 21 studies and 125 cases where bevacizumab had been used for the treatment of RN. The median follow-up was 8 months and the most frequent bevacizumab dose used was 7.5 mg/kg for 2 weeks with a median of four cycles. Low-dose bevacizumab resulted in effectiveness with improvement in both clinical and radiographic response. The median decrease in T1 contrast enhancement and in T2/FLAIR signal abnormality was 64% and 60%, respectively. A reduction in steroidal therapy was observed in majority of patients treated. Based on the data of our review, bevacizumab appears to be a promising agent for the treatment of brain RN. Future prospective studies are required to evaluate the role of bevacizumab in RN and to define the optimal scheduling, dosage and duration of therapy.
脑组织放射性坏死（RN）是脑部放疗严重的晚期并发症，近来贝伐单抗被提议作为RN的治疗选择。关于贝伐单抗治疗RN的有效性，文献中缺乏相关数据。本综述的目的是对所有报道的使用贝伐单抗治疗脑部RN的病例进行全面分析。2016年9月，我们对以下电子数据库进行了全面的文献检索：PubMed、科学网、Scopus和Cochrane图书馆。本综述的研究使用了“放射性坏死”“放射治疗”和“贝伐单抗”等关键词，并结合文章标题、摘要和关键词字段进行。本综述纳入了随机试验、非随机试验、前瞻性研究、回顾性研究和单病例报告。我们的研究共产生了21项研究和125例使用贝伐单抗治疗RN的病例。中位随访时间为8个月，最常用的贝伐单抗剂量是7.5mg/kg，持续2周，中位疗程为4个周期。低剂量贝伐单抗治疗有效，临床和影像学反应均有改善。T1加权像对比增强和T2/液体衰减反转恢复序列信号异常的中位降低率分别为64%和60%。在大多数接受治疗的患者中观察到甾体类药物治疗的减少。基于我们综述的数据，贝伐单抗似乎是治疗脑部RN的一种有前景的药物。需要未来的前瞻性研究来评估贝伐单抗在RN中的作用，并确定最佳的治疗方案、剂量和疗程。
