基于分期立体定向放射外科和贝伐单抗的“三明治疗法”治疗大脑干转移瘤的疗效和安全性。
Efficacy and safety of a "sandwich therapy" based on staged stereotactic radiosurgery and bevacizumab for large brainstem metastases.
机构信息
Cancer Center, Department of Gamma Knife Treatment, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China.
Gamma Knife Treatment Center, Anhui Provincial Hospital, The First Affiliated Hospital of University of Science and Technology of China, Hefei 230001, China.
出版信息
Clin Neurol Neurosurg. 2023 Oct;233:107911. doi: 10.1016/j.clineuro.2023.107911. Epub 2023 Jul 24.
OBJECTIVE
Gamma Knife stereotactic radiosurgery (SRS) is an effective therapeutic option for unresectable brainstem metastases. Currently, staged stereotactic radiosurgery (SSRS) has become available for large brainstem metastases（≥ 1 cm） despite the limitation of peritumoral edema. The authors developed the so-called "sandwich therapy" which integrated 2-stage stereotactic radiosurgery (2-SSRS) with bevacizumab for peritumoral edema reduction and local control of large brainstem metastases.
METHODS
42 patients with large brainstem metastases ≥1 cm who received 2-SSRS simultaneously with bevacizumab were screened from 2019 to 2021 retrospectively. The first SRS margin doses were 13 Gy (range 11-15) and the second SRS margin doses were 12 Gy (range 11-13), one-time vascular endothelial growth factor (VEGF) inhibitor (bevacizumab) of 3.5-5 mg/kg was administrated intravenously the next day after the first SRS. The median interval between the two sessions of SRS was 6 days. Baseline demographics, clinical and radiology imaging follow-ups were recorded to determine symptomatic improvement, peritumoral edema reduction, local control, and disease progression. Median survival was calculated using Kaplan-Meier analysis. Multivariate analysis was performed to identify prognostic factors.
RESULTS
The "sandwich therapy" was applied to 42 lesions. Significant reductions of tumor volume (p < 0.05) and peritumoral edema volume (p < 0.01) were achieved at the second SRS in comparison to those at the first SRS. The proportion of favorable Karnofsky performance scale (KPS) (≥80 %) increased significantly at early follow-up time points and reached the highest value of 85.7 %. The median survival time was 9.7 months, the median local control duration was 11.3 months. 8 acute adverse events of CTCAE grade 2 and 3 were observed in 6 patients and resolved with palliative treatment. Tyrosine kinase inhibitor (TKI) treatment was identified as a predictive factor for longer survival.
CONCLUSION
The "sandwich therapy" which integrates 2-SSRS with bevacizumab is a safe and effective option for large brainstem metastases.
目的
伽玛刀立体定向放射外科（SRS）是治疗无法切除的脑干转移瘤的有效治疗选择。目前，尽管存在瘤周水肿的限制，分期立体定向放射外科（SSRS）已可用于大的脑干转移瘤（≥1cm）。作者开发了所谓的“三明治治疗”，将 2 期立体定向放射外科（2-SSRS）与贝伐单抗相结合，以减少瘤周水肿并控制大的脑干转移瘤的局部进展。
方法
回顾性筛选了 2019 年至 2021 年期间接受 2-SSRS 联合贝伐单抗治疗的 42 例大的脑干转移瘤（≥1cm）患者。第一次 SRS 边缘剂量为 13Gy（范围 11-15），第二次 SRS 边缘剂量为 12Gy（范围 11-13），第一次 SRS 后第二天单次给予 3.5-5mg/kg 的血管内皮生长因子（VEGF）抑制剂（贝伐单抗）。两次 SRS 之间的中位间隔为 6 天。记录基线人口统计学、临床和影像学随访，以确定症状改善、瘤周水肿减轻、局部控制和疾病进展。使用 Kaplan-Meier 分析计算中位生存期。进行多变量分析以确定预后因素。
结果
“三明治治疗”应用于 42 个病灶。与第一次 SRS 相比，第二次 SRS 时肿瘤体积（p<0.05）和瘤周水肿体积（p<0.01）明显减少。早期随访时，Karnofsky 表现状态（KPS）（≥80%）的比例显著增加，达到 85.7%的最高值。中位生存期为 9.7 个月，中位局部控制持续时间为 11.3 个月。6 例患者出现 8 例 CTCAE 2 级和 3 级急性不良事件，经姑息治疗后缓解。酪氨酸激酶抑制剂（TKI）治疗被确定为生存时间延长的预测因素。
结论
将 2-SSRS 与贝伐单抗相结合的“三明治治疗”是治疗大的脑干转移瘤的一种安全有效的选择。
Zotero 插件