Weng Yuxiang, Shen Jie, Zhang Luyuan, Fang Zebin, Xiao Feng, Zhang Chao, Fan Zuoxu, Huang Kaiyuan, Wang Liyun, Huang Bin, Wu Fan, Zhang Tiesong, Xu Qingsheng
Department of Neurosurgery, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China.
Department of Neurosurgery, Shengzhou People's Hospital, Shaoxing, China.
Front Surg. 2021 Sep 3;8:720506. doi: 10.3389/fsurg.2021.720506. eCollection 2021.
Cerebral radiation necrosis (RN), a complication of Gamma Knife radiosurgery, is difficult to treat, although bevacizumab seems to be effective. However, clinical data pertaining to bevacizumab treatment for RN are scarce, and its high price is problematic. This study explored the effectiveness of low-dose bevacizumab for RN caused by Gamma Knife. We retrospectively analyzed 22 patients who suffered cerebral RN post-Gamma Knife, and received bevacizumab treatment because of the poor efficacy of glucocorticoids. Low-dose bevacizumab (3 mg/kg) was administered for two cycles at 2-week intervals. T1- and T2-enhanced magnetic resonance imaging (MRI) images were examined for changes in RN status. We also monitored the dose of glucocorticoid, Karnofsky Performance Status (KPS) score, and adverse drug reactions. The mean volume of RN lesions decreased by 45% on T1-weighted images with contrast enhancement, and by 74% on T2-weighted images. All patients discontinued the use of glucocorticoids. According to the KPS scores, all patients showed an improvement in their symptoms and neurological function. No side effects were observed. Low-dosage bevacizumab at a dose of 3 mg/kg every 2 weeks is effective for treating cerebral RN after Gamma knife for brain metastases.
脑放射性坏死（RN）是伽玛刀放射外科手术的一种并发症，尽管贝伐单抗似乎有效，但治疗起来很困难。然而，关于贝伐单抗治疗RN的临床数据很少，而且其价格高昂也是个问题。本研究探讨了低剂量贝伐单抗对伽玛刀所致RN的有效性。我们回顾性分析了22例伽玛刀术后发生脑RN且因糖皮质激素疗效不佳而接受贝伐单抗治疗的患者。低剂量贝伐单抗（3mg/kg）每2周给药1次，共2个周期。通过T1加权和T2加权增强磁共振成像（MRI）检查RN状态的变化。我们还监测了糖皮质激素的剂量、卡氏功能状态（KPS）评分以及药物不良反应。在T1加权对比增强图像上，RN病灶的平均体积减少了45%，在T2加权图像上减少了74%。所有患者均停用了糖皮质激素。根据KPS评分，所有患者的症状和神经功能均有改善。未观察到副作用。每2周一次剂量为3mg/kg的低剂量贝伐单抗对治疗脑转移瘤伽玛刀术后的脑RN有效。
