Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Neurol India. 2019 Sep-Oct;67(5):1292-1302. doi: 10.4103/0028-3886.271242.
Radiation-induced brain edema (RIBE) is a serious complication of radiation therapy. It may result in dramatic clinico-radiological deterioration. At present, there are no definite guidelines for management of the complication. Corticosteroids are the usual first line of treatment, which frequently fails to provide long-term efficacy in view of its adverse complication profile. Bevacizumab has been reported to show improvement in cases of steroid-resistant radiation injury. The objective of this study is to evaluate the role of Bevacizumab in post-radiosurgery RIBE.
Since 2012, 189 out of 1241 patients who underwent radiosurgery at our institution developed post-radiosurgery RIBE, 17 of which did not respond to high-dose corticosteroids. We systematically reviewed these 17 patients of various intracranial pathologies with clinic-radiological evidence of RIBE following gamma knife radiosurgery (GKRS). All patients received protocol-based Bevacizumab therapy. The peer-reviewed literature was evaluated.
82 percent of the patients showed improvement after starting Bevacizumab. The majority began to improve after the third cycle started improvement after the third cycle of Bevacizumab. Clinical improvement preceded radiological improvement by an average of eight weeks. The first dose was 5 mg/kg followed by 7.5-10 mg/kg at with two-week intervals. Bevacizumab needs to be administered for an average of seven cycles (range 5-27, median 7) for best response. Steroid therapy could be tapered in most patients by the first follow-up. One patient did not respond to Bevacizumab and needed surgical decompression for palliative care. One noncompliant patient died due to radiation injury.
Bevacizumab is a effective and safe for treatment of RIBE after GKRS. A protocol-based dose schedule in addition to frequent clinical and radiological evaluations are required. Bevacizumab should be considered as an early treatment option for RIBE.
放射性脑水肿（RIBE）是放射治疗的严重并发症，可能导致临床和影像学急剧恶化。目前，对于这种并发症的治疗还没有明确的指南。皮质类固醇是常用的一线治疗方法，但由于其不良反应的影响，在长期疗效方面常常不尽如人意。贝伐单抗已被报道在治疗类固醇抵抗性放射性损伤方面有改善作用。本研究旨在评估贝伐单抗在放射外科手术后放射性脑水肿（RIBE）中的作用。
自 2012 年以来，在我们机构接受放射外科手术的 1241 名患者中，有 189 名患者发生了放射外科手术后放射性脑水肿（RIBE），其中 17 名患者对高剂量皮质类固醇治疗没有反应。我们系统地回顾了这 17 名患有各种颅内病变的患者，他们在伽玛刀放射外科手术后（GKRS）出现了放射性脑水肿（RIBE）的临床和影像学证据。所有患者均接受了基于方案的贝伐单抗治疗。我们评估了同行评议的文献。
82%的患者在开始使用贝伐单抗后有所改善。大多数患者在开始第三个周期的贝伐单抗后开始改善，在开始治疗后平均 8 周出现临床改善，在开始治疗后平均 8 周出现影像学改善。第一个剂量为 5mg/kg，然后每两周以 7.5-10mg/kg 的剂量递增。为了获得最佳反应，贝伐单抗需要平均使用 7 个周期（范围 5-27，中位数 7）。大多数患者在首次随访时可以逐渐减少类固醇治疗。一名患者对贝伐单抗无反应，需要手术减压以进行姑息治疗。一名不配合的患者因放射性损伤而死亡。
贝伐单抗是 GKRS 后治疗 RIBE 的有效且安全的方法。需要制定基于方案的剂量方案，并进行频繁的临床和影像学评估。贝伐单抗应被视为 RIBE 的早期治疗选择。
