Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, T-Wing 2nd Floor, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada.
Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
J Neurooncol. 2019 Jul;143(3):475-481. doi: 10.1007/s11060-019-03179-y. Epub 2019 May 3.
Radiation-induced pseudoprogression is a subacute clinical entity that is distinct from radiation necrosis and mimics tumor progression. Bevacizumab is a well-described treatment option for radiation necrosis, but its role in pseudoprogression is not clearly defined.
We report a case of radiation-induced pseudoprogression rescued with bevacizumab in a 20-year-old man with a biopsy-proven low-grade astrocytoma of the tectum. A review of the literature was also conducted specific to bevacizumab as a treatment for symptomatic pseudoprogression after radiotherapy for CNS tumors.
This patient was treated with definitive intensity modulated stereotactic radiotherapy at a total dose of 54 Gy delivered in 30 daily fractions. Six weeks after radiotherapy the patient developed progressive headache, weakness and a documented deterioration in vision, which was accompanied by worsening of radiographic findings. A diagnosis of pseudoprogression was made and after limited benefit from a trial of dexamethasone, four cycles of bevacizumab were administered which resulted in rapid clinical and radiographic improvement.
Our findings support the potential use of bevacizumab as a rescue agent for symptomatic pseudoprogression.
辐射诱导的假性进展是一种亚急性临床实体，与放射性坏死不同，且类似于肿瘤进展。贝伐单抗是放射性坏死的一种公认的治疗选择，但它在假性进展中的作用尚未明确。
我们报告了一例 20 岁男性患者的病例，该患者经活检证实为颅后窝低度星形细胞瘤，在接受全脑放疗后出现假性进展，接受贝伐单抗治疗后得以缓解。我们还专门对贝伐单抗作为治疗中枢神经系统肿瘤放疗后症状性假性进展的治疗方法进行了文献回顾。
该患者接受了总剂量为 54 Gy 的 30 次分割的调强立体定向放疗。放疗后 6 周，患者出现进行性头痛、无力和视力明显下降，并伴有影像学表现恶化，诊断为假性进展。在尝试使用地塞米松治疗后仅获得有限疗效后，给予该患者贝伐单抗 4 个周期治疗，结果患者的临床和影像学均迅速改善。
我们的研究结果支持贝伐单抗作为治疗症状性假性进展的挽救性药物的潜在用途。
