Clinical study of bevacizumab in the treatment of refractory cerebral edema

doi:10.3877/cma.j.issn.2095-123X.2021.04.004

Abstract

Abstract:

Objective

To observe the clinical effect of bevacizumab in the treatment of refractory brain edema.

Methods

Eight patients with refractory brain edema who were treated with regular dehydration and hormone for one week in the neurosurgical intensive care unit of Neurosurgery Department of Nanjin Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from July 2020 to June 2021 were selected as the research objects. All patients were given bevacizumab 200 mg, diluted to 0.8 mg/mL with 250 mL normal saline under sterile technology, and continued intravenous drip for more than 90 min. The amount of brain edema and the improvement of GCS score were compared before and after treatment.

Results

For patients with refractory brain edema, bevacizumab could significantly improve brain edema. Imaging examination showed that brain edema was improved 2 d after treatment. The amount of brain edema measured 1 week after treatment of all patients were relieved compared with that before treatment, and the GCS score of all patients were higher than that before treatment.

Conclusion

Bevacizumab is effective in the treatment of neurosurgical refractory brain edema, which can reduce brain edema and improve the clinical prognosis.

Key words: Refractory brain edema, Bevacizumab, Prognosis

Longyang Cheng, Shaoya Li, Chunlei Chen, Juan Wang, Manman Xu, Haibin Dai, Penglai Zhao. Clinical study of bevacizumab in the treatment of refractory cerebral edema[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2021, 11(04): 204-208.

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References 17

[1]	中国医师协会神经外科医师分会，中国神经创伤专家委员会. 中国颅脑创伤颅内压监测专家共识[J]. 中华神经外科杂志, 2011, 27(10): 1073-1074.
[2]	Klatzo I. Pathophysiological aspects of brain edema[J]. Acta Neuropathol, 1987, 72(3): 236-239.
[3]	Cook AM, Morgan Jones G, Hawryluk GWJ, et al. Guidelines for the acute treatment of cerebral edema in neurocritical care patients[J]. Neurocrit Care, 2020, 32(3): 647-666.
[4]	王浩，胡深，冯诣, 等. 贝伐单抗靶向治疗重度脑水肿临床研究及评估[J]. 临床军医杂志, 2016, 44(9): 904-906.
[5]	Stokum JA, Gerzanich V, Simard JM. Molecular pathophysiology of cerebral edema[J]. J Cereb Blood Flow Metab, 2016, 36(3): 513-538.
[6]	Simons M, Gordon E, Claesson-Welsh L. Mechanisms and regulation of endothelial VEGF receptor signalling[J]. Nat Rev Mol Cell Biol, 2016, 17(10): 611-625.
[7]	Rattner A, Williams J, Nathans J. Roles of HIFs and VEGF in angiogenesis in the retina and brain[J]. J Clin Invest, 2019, 129(9): 3807-3820.
[8]	Zhuang H, Shi S, Yuan Z, et al. Bevacizumab treatment for radiation brain necrosis: mechanism, efficacy and issues[J]. Mol Cancer, 2019, 18(1): 21.
[9]	Naikoo NA, Dil-Afroze , Rasool R, et al. Upregulation of vascular endothelial growth factor (VEGF), its role in progression and prognosis of non-small cell lung carcinoma[J]. Cancer Genet, 2017, 216-217: 67-73.
[10]	Gonzalez J, Kumar AJ, Conrad CA, et al. Effect of bevacizumab on radiation necrosis of the brain[J]. Int J Radiat Oncol Biol Phys, 2007, 67(2): 323-326.
[11]	Tripathi M, Ahuja CK, Mukherjee KK, et al. The safety and efficacy of bevacizumab for radiosurgery-induced steroid-resistant brain edema; not the last part in the ship of theseus[J]. Neurol India, 2019, 67(5): 1292-1302.
[12]	Voss M, Wenger KJ, Fokas E, et al. Single-shot bevacizumab for cerebral radiation injury[J]. BMC Neurol, 2021, 21(1): 77.
[13]	Rahbari NN, Kedrin D, Incio J, et al. Anti-VEGF therapy induces ECM remodeling and mechanical barriers to therapy in colorectal cancer liver metastases[J]. Sci Transl Med, 2016, 8(360): 360ra135.
[14]	Zhan Q, Miao F, Huang R, et al. Efficacy and safety of bevacizumab combined with chemotherapy in symptomatic brain metastases from lung adenocarcinoma: a retrospective analysis[J]. J Thorac Dis, 2019, 11(11): 4725-4734.
[15]	赵儒钢，孟祥颖，申戈, 等. 贝伐珠单抗治疗脑转移瘤难治性瘤周水肿的疗效分析?[J]. 临床肿瘤学杂志, 2016, 21(3): 233-237.
[16]	Halstead MR, Geocadin RG. The medical management of cerebral edema: past, present, and future therapies[J]. Neurotherapeutics, 2019, 16(4): 1133-1148.
[17]	杨三虎，高红祥，崔立春, 等. 贝伐珠单抗治疗非小细胞肺癌脑转移伴顽固性瘤周水肿的临床分析[J]. 中华肺部疾病杂志(电子版), 2020, 13(5): 676-678.

病例	性别	年龄（岁）	病因	GCS评分（分）	脑水肿体积（mL）
1	女	59	大面积脑梗死	10	28.32
2	男	64	缺血缺氧性脑病	3	32.13
3	女	66	胶质瘤术后	5	24.87
4	男	56	基底节区脑出血	8	22.41
5	男	57	蛛网膜下腔出血	12	18.38
6	女	64	小脑出血	6	17.67
7	男	69	大面积脑梗死	3	29.56
8	女	59	蛛网膜下腔出血	3	21.88

病例	性别	年龄（岁）	病因	GCS评分（分）	脑水肿体积（mL）
1	女	59	大面积脑梗死	10	28.32
2	男	64	缺血缺氧性脑病	3	32.13
3	女	66	胶质瘤术后	5	24.87
4	男	56	基底节区脑出血	8	22.41
5	男	57	蛛网膜下腔出血	12	18.38
6	女	64	小脑出血	6	17.67
7	男	69	大面积脑梗死	3	29.56
8	女	59	蛛网膜下腔出血	3	21.88

病例	GCS评分（分）		用药1周后脑水肿体积（mL）
病例	用药1周后	用药3个月后	用药1周后脑水肿体积（mL）
1	15	15	19.31
2	3	3	21.46
3	14	15	15.18
4	15	15	16.23
5	14	15	11.21
6	14	15	12.41
7	3	13	21.55
8	5	9	16.28

病例	GCS评分（分）		用药1周后脑水肿体积（mL）
病例	用药1周后	用药3个月后	用药1周后脑水肿体积（mL）
1	15	15	19.31
2	3	3	21.46
3	14	15	15.18
4	15	15	16.23
5	14	15	11.21
6	14	15	12.41
7	3	13	21.55
8	5	9	16.28

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