School of Basic Medical Sciences, Capital Medical University, Beijing, China.
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, China.
Front Immunol. 2024 Aug 27;15:1399613. doi: 10.3389/fimmu.2024.1399613. eCollection 2024.
Cerebral radiation necrosis (RN), a severe complication of stereotactic radiotherapy (SRT), has been shown to significantly decrease patient survival time and quality of life. The purpose of this study was to analyze whether bevacizumab can prevent or reduce the occurrence of SRT-induced cerebral RN in non-small cell lung cancer (NSCLC) patients with brain metastases.
We retrospectively reviewed the clinical records of NSCLC patients with brain metastases from March 2013 to June 2023 who were treated with SRT. Patients were divided into two groups: those in the bevacizumab group received SRT with four cycles of bevacizumab, and patients in the control group received SRT only. Inverse probability of treatment weighting (IPTW) was performed based on a multinomial propensity score model to balance the baseline characteristics. The chi-square test was used. A Cox model was used to evaluate overall survival (OS).
A total of 80 patients were enrolled, namely, 28 patients in the bevacizumab group and 52 patients in the control group. The possibility of developing cerebral RN and/or symptomatic edema (RN/SE) was significantly decreased in patients treated with bevacizumab compared to those who did not receive bevacizumab before IPTW (p=0.036) and after IPTW (p=0.015) according to chi-square analysis. The IPTW-adjusted median OS was 47.7 months (95% CI 27.4-80.8) for patients in the bevacizumab group and 44.1 months (95% CI 36.7-68.0) (p=0.364) for patients in the control group.
The application of bevacizumab concurrent with SRT may prevent or reduce the occurrence of cerebral RN in NSCLC patients with brain metastases.
立体定向放射治疗（SRT）引起的放射性脑坏死（RN）是一种严重的并发症，它显著降低了患者的生存时间和生活质量。本研究旨在分析贝伐珠单抗是否可以预防或减少非小细胞肺癌（NSCLC）伴脑转移患者 SRT 引起的脑 RN 的发生。
我们回顾性分析了 2013 年 3 月至 2023 年 6 月期间接受 SRT 治疗的 NSCLC 伴脑转移患者的临床资料。患者分为贝伐珠单抗组（n=28）和对照组（n=52）。采用多变量倾向评分模型进行逆概率治疗加权（IPTW）以平衡基线特征。采用卡方检验。采用 Cox 模型评估总生存期（OS）。
共纳入 80 例患者，贝伐珠单抗组 28 例，对照组 52 例。贝伐珠单抗组患者发生放射性脑坏死和/或症状性水肿（RN/SE）的可能性明显低于未接受贝伐珠单抗治疗的患者（校正前：p=0.036；校正后：p=0.015）。根据 IPTW 校正的中位 OS 为贝伐珠单抗组 47.7 个月（95%CI 27.4-80.8），对照组为 44.1 个月（95%CI 36.7-68.0）（p=0.364）。
SRT 联合贝伐珠单抗的应用可能预防或减少 NSCLC 伴脑转移患者脑 RN 的发生。
