Liu Ruifeng, Luo Hongtao, Zhang Qiuning, Sun Shilong, Liu Zhiqiang, Wang Xiaohu, Geng Yichao, Zhao Xueshan
Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, Gansu 730000, P.R. China.
Graduate School, University of Chinese Academy of Sciences, Beijing 100190, P.R. China.
Mol Clin Oncol. 2022 May 19;17(1):114. doi: 10.3892/mco.2022.2547. eCollection 2022 Jul.
Carbon ion therapy (CIT) is a form of particle therapy, which not only spares normal tissues but may also improve local control of recurrent intracranial tumours. Cerebral radiation necrosis (RN) is one of the most serious adverse reactions of recurrent brain tumours following reirradiation, which may lead to neurological decline or even death. Bevacizumab is an anti-vascular endothelial growth factor antibody, which has been used to treat symptomatic RN. However, studies on bevacizumab for the treatment of CIT-induced RN are sparse. The present study described two cases that were successfully treated with bevacizumab for symptomatic RN following CIT for recurrent intracranial malignant tumours. The two recurrent intracranial malignant tumours, a chondrosarcoma in the right cavernous sinus and an anaplastic meningioma in the right frontal lobe, were enrolled in a clinical trial of CIT. Both cases were treated intravenously with bevacizumab when deterioration that appeared to be symptomatic brain RN was observed. Just before CIT, enhanced magnetic resonance imaging (MRI) was performed in each case to confirm tumour recurrence. Both cases exhibited a deterioration in symptoms, as well as on MRI, at 12-month intervals following CIT. The first case underwent positron emission tomography/computed tomography to confirm no increase in fluorodeoxyglucose uptake in lesion areas. Both cases were diagnosed as having symptomatic brain RN and began intravenous administration of four cycles of 5 mg/kg bevacizumab biweekly. The patients responded well, with rapid and marked improvements on MRI, and in clinical symptoms. No tumour progression was observed 24 months after CIT. In conclusion, bevacizumab was revealed to exert marked effects on symptomatic brain RN following CIT. Notably, cycles of bevacizumab should be administered specifically based on the aim of treating brain necrosis, and long-term or prophylactic applications are not recommended.
碳离子治疗（CIT）是一种粒子治疗形式，它不仅能使正常组织免受辐射，还可能改善复发性颅内肿瘤的局部控制。脑放射性坏死（RN）是再照射后复发性脑肿瘤最严重的不良反应之一，可能导致神经功能衰退甚至死亡。贝伐单抗是一种抗血管内皮生长因子抗体，已被用于治疗有症状的RN。然而，关于贝伐单抗治疗CIT诱导的RN的研究很少。本研究描述了两例复发性颅内恶性肿瘤接受CIT后出现有症状的RN并成功接受贝伐单抗治疗的病例。这两例复发性颅内恶性肿瘤，一例是右侧海绵窦软骨肉瘤，另一例是右侧额叶间变性脑膜瘤，均纳入了CIT临床试验。当观察到出现疑似有症状的脑RN恶化时，两例均静脉注射贝伐单抗。在CIT前，每例均进行增强磁共振成像（MRI）以确认肿瘤复发。两例在CIT后每隔12个月症状以及MRI表现均出现恶化。第一例接受正电子发射断层扫描/计算机断层扫描以确认病变区域氟脱氧葡萄糖摄取没有增加。两例均被诊断为有症状的脑RN，并开始每两周静脉注射4个周期、剂量为5mg/kg的贝伐单抗。患者反应良好，MRI及临床症状迅速且显著改善。CIT后24个月未观察到肿瘤进展。总之，贝伐单抗被证明对CIT后有症状的脑RN有显著疗效。值得注意的是，贝伐单抗的疗程应根据治疗脑坏死的目的具体给药，不建议长期或预防性应用。
