Park Moowan, Gwak Ho Shin, Lee Sang Hyeon, Lee Young Joo, Kwon Ji Woong, Shin Sang Hoon, Yoo Heon
Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
Department of Cancer Control, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.
Brain Tumor Res Treat. 2020 Oct;8(2):93-102. doi: 10.14791/btrt.2020.8.e11. Epub 2020 Jul 9.
As the application of radiotherapy to brain metastasis (BM) increases, the incidence of radiation necrosis (RN) as a late toxicity of radiotherapy also increases. However, no specific treatment for RN is indicated except long-term steroids. Here, we summarize the clinical results of bevacizumab (BEV) for RN.
Ten patients with RN who were treated with BEV monotherapy (7 mg/kg) were retrospectively reviewed. RN diagnosis was made using MRI with or without perfusion MRI. Radiological response was based on Response Assessment in Neuro-Oncology criteria for BM. The initial response was observed after 2 cycles every 2 weeks, and maintenance observed after 3 cycles every 3-6 weeks of increasing length intervals.
The initial response of gadolinium (Gd) enhancement diameter maintained stable disease (SD) in 9 patients, and 1 patient showed partial response (PR). The initial fluid-attenuated inversion recovery (FLAIR) response showed PR in 4 patients and SD in 6 patients. The best radiological response was observed in 9 patients. Gd enhancement response was 6 PR and 3 SD between 15-43 weeks. Reduction of FLAIR showed PR in 5 patients and SD in 4 patients. Clinical improvement was observed in all but 1 patient. Five patients were maintained on protocol with durable response up to 23 cycles. However, 2 patients stopped treatment due to primary cancer progression, 1 patient received surgical removal from tumor recurrence, and 1 patient changed to systemic chemotherapy for new BM. Grade 3 intractable hypertension occurred in 1 patient who had already received antihypertensive medication.
BEV treatment for RN from BM radiotherapy resulted in favorable radiological (60%) and clinical responses (90%). Side effects were expectable and controllable. We anticipate prospective clinical trials to verify the effect of BEV monotherapy for RN.
随着放射治疗在脑转移瘤（BM）中的应用增加，作为放射治疗晚期毒性的放射性坏死（RN）的发生率也在上升。然而，除了长期使用类固醇外，尚无针对RN的特异性治疗方法。在此，我们总结了贝伐单抗（BEV）治疗RN的临床结果。
回顾性分析10例接受BEV单药治疗（7mg/kg）的RN患者。采用MRI（有无灌注MRI）进行RN诊断。放射学反应基于神经肿瘤学BM反应评估标准。每2周进行2个周期治疗后观察初始反应，每3 - 6周进行3个周期治疗后观察维持反应，周期间隔逐渐延长。
钆（Gd）增强直径的初始反应显示9例患者病情稳定（SD），1例患者部分缓解（PR）。初始液体衰减反转恢复（FLAIR）反应显示4例患者PR，6例患者SD。9例患者观察到最佳放射学反应。15 - 43周期间，Gd增强反应为6例PR和3例SD。FLAIR降低显示5例患者PR，4例患者SD。除1例患者外，其余患者均有临床改善。5例患者按方案维持治疗，持久反应达23个周期。然而，2例患者因原发癌进展停止治疗，1例患者因肿瘤复发接受手术切除，1例患者因新发BM改为全身化疗。1例已接受抗高血压药物治疗的患者发生3级顽固性高血压。
BEV治疗BM放疗所致RN产生了良好的放射学反应（60%）和临床反应（90%）。副作用可预期且可控。我们期待进行前瞻性临床试验以验证BEV单药治疗RN的效果。
