Ali Sheikh C, Basil Gregory W, Diaz Roberto J, Komotar Ricardo J
College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA.
Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
World Neurosurg. 2018 Sep;117:e588-e594. doi: 10.1016/j.wneu.2018.06.092. Epub 2018 Jun 19.
Laser interstitial thermal therapy (LITT) enables ablation of lesions using thermal energy with minimal damage to surrounding regions. Bevacizumab has been used as an adjuvant therapy in recurrent glioblastoma (GBM). At present, bevacizumab is administered at least 4-6 weeks after surgical intervention; however, given the minimally invasive nature of LITT, we suggest that bevacizumab can be safely administered at a shorter interval after LITT.
Three patients who showed evidence of recurrent GBM on magnetic resonance imaging (MRI), underwent LITT, and were subsequently administered bevacizumab within 4 weeks were identified retrospectively. Postoperative MRI was performed 24 hours after treatment and before follow-up. All 3 patients were placed on dexamethasone taper postoperatively. The ablated tumors were analyzed radiographically, and bevacizumab symptoms were monitored carefully.
The patients ranged in age from 39 to 69 years. The median duration of follow-up was 26 weeks (range, 13-51 weeks). All 3 patients expired due to disease progression. The median progression-free survival (PFS) was 17 weeks (range, 12-22 weeks), and the median overall survival (OS) was 32 weeks (range, 12-51 weeks). There were no postoperative complications or complications due to hemorrhage, infection, or thrombosis (complication rate, 0%; 95% confidence interval 0-56%).
This case series suggests that bevacizumab administration is safe within 1 month after LITT, thus showing promise in treating recurrent GBM. Larger studies are warranted to assess the efficacy of combined bevacizumab and LITT.
激光间质热疗（LITT）能够利用热能消融病变，对周围区域的损伤最小。贝伐单抗已被用作复发性胶质母细胞瘤（GBM）的辅助治疗。目前，贝伐单抗在手术干预后至少4 - 6周给药；然而，鉴于LITT的微创性质，我们认为贝伐单抗在LITT后更短的时间间隔内给药是安全的。
回顾性确定3例磁共振成像（MRI）显示复发性GBM证据、接受LITT治疗并随后在4周内接受贝伐单抗治疗的患者。治疗后24小时及随访前进行术后MRI检查。所有3例患者术后均接受地塞米松减量治疗。对消融的肿瘤进行影像学分析，并仔细监测贝伐单抗的症状。
患者年龄在39至69岁之间。中位随访时间为26周（范围13 - 51周）。所有3例患者均因疾病进展死亡。中位无进展生存期（PFS）为17周（范围12 - 22周），中位总生存期（OS）为32周（范围12 - 51周）。没有术后并发症或因出血、感染或血栓形成导致的并发症（并发症发生率0%；95%置信区间0 - 56%）。
该病例系列表明，LITT后1个月内给予贝伐单抗是安全的，因此在治疗复发性GBM方面显示出前景。需要进行更大规模的研究来评估贝伐单抗与LITT联合治疗的疗效。
