Department of Oncology, Shenzhen People's Hospital, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, 518020, People's Republic of China.
Department of Oncology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, People's Republic of China.
BMC Cancer. 2021 Feb 16;21(1):167. doi: 10.1186/s12885-021-07889-3.
Radiotherapy is the mainstay of brain metastasis (BM) management. Radiation necrosis (RN) is a serious complication of radiotherapy. Bevacizumab (BV), an anti-vascular endothelial growth factor monoclonal antibody, has been increasingly used for RN treatment. We systematically reviewed the medical literature for studies reporting the efficacy and safety of bevacizumab for treatment of RN in BM patients.
PubMed, Medline, EMBASE, and Cochrane library were searched with various search keywords such as "bevacizumab" OR "anti-VEGF monoclonal antibody" AND "radiation necrosis" OR "radiation-induced brain necrosis" OR "RN" OR "RBN" AND "Brain metastases" OR "BM" until 1st Aug 2020. Studies reporting the efficacy and safety of BV treatment for BM patients with RN were retrieved. Study selection and data extraction were carried out by independent investigators. Open Meta Analyst software was used as a random effects model for meta-analysis to obtain mean reduction rates.
Two prospective, seven retrospective, and three case report studies involving 89 patients with RN treated with BV were included in this systematic review and meta-analysis. In total, 83 (93%) patients had a recorded radiographic response to BV therapy, and six (6.7%) had experienced progressive disease. Seven studies (n = 73) reported mean volume reductions on gadolinium-enhanced T1 (mean: 47.03%, +/- 24.4) and T2-weighted fluid-attenuated inversion recovery (FLAIR) MRI images (mean: 61.9%, +/- 23.3). Pooling together the T1 and T2 MRI reduction rates by random effects model revealed a mean of 48.58 (95% CI: 38.32-58.85) for T1 reduction rate and 62.017 (95% CI: 52.235-71.799) for T2W imaging studies. Eighty-five patients presented with neurological symptoms. After BV treatment, nine (10%) had stable symptoms, 39 (48%) had improved, and 34 (40%) patients had complete resolution of their symptoms. Individual patient data was available for 54 patients. Dexamethasone discontinuation or reduction in dosage was observed in 30 (97%) of 31 patients who had recorded dosage before and after BV treatment. Side effects were mild.
Bevacizumab presents a promising treatment strategy for patients with RN and brain metastatic disease. Radiographic response and clinical improvement was observed without any serious adverse events. Further class I evidence would be required to establish a bevacizumab recommendation in this group of patients.
放射治疗是脑转移瘤（BM）管理的主要手段。放射性坏死（RN）是放射治疗的严重并发症。贝伐单抗（BV），一种抗血管内皮生长因子的单克隆抗体，已越来越多地用于 RN 的治疗。我们系统地检索了医学文献，以获取报告贝伐单抗治疗 BM 患者 RN 疗效和安全性的研究。
使用各种搜索关键词，如“bevacizumab”或“抗血管内皮生长因子单克隆抗体”和“radiation necrosis”或“radiation-induced brain necrosis”或“RN”或“RBN”和“Brain metastases”或“BM”，在 PubMed、Medline、EMBASE 和 Cochrane 图书馆中进行搜索，检索截至 2020 年 8 月 1 日。检索报告贝伐单抗治疗 BM 患者 RN 的疗效和安全性的研究。由独立调查员进行研究选择和数据提取。使用 Open Meta Analyst 软件作为随机效应模型进行荟萃分析，以获得平均减少率。
本系统评价和荟萃分析纳入了 2 项前瞻性研究、7 项回顾性研究和 3 项病例报告研究，共 89 例接受 BV 治疗的 RN 患者。共有 83 名（93%）患者的放射性坏死经贝伐单抗治疗后有影像学记录的反应，6 名（6.7%）患者出现疾病进展。7 项研究（n=73）报告了钆增强 T1 加权（mean：47.03%，+/-24.4）和 T2 加权液体衰减反转恢复（FLAIR）MRI 图像（mean：61.9%，+/-23.3）的平均体积减少。通过随机效应模型汇总 T1 和 T2 MRI 减少率，T1 减少率的平均值为 48.58（95%置信区间：38.32-58.85），T2W 成像研究的平均值为 62.017（95%置信区间：52.235-71.799）。85 名患者出现神经症状。在接受贝伐单抗治疗后，9 名（10%）患者的症状稳定，39 名（48%）患者的症状改善，34 名（40%）患者的症状完全缓解。54 名患者有个人患者数据。31 名记录了贝伐单抗治疗前后剂量的患者中，有 30 名（97%）停用或减少了地塞米松的剂量。副作用轻微。
贝伐单抗为 RN 和脑转移瘤患者提供了一种有前途的治疗策略。未观察到严重不良事件，同时观察到影像学反应和临床改善。需要进一步的 I 级证据来确定贝伐单抗在这组患者中的推荐应用。
