| 90% of brain metastases are associated with peritumoral brain edema(PTBE). PTBE increased the occupying volume, deteriorate clinical symptoms, affecting the implementation of the program of radiotherapy, and can create conditions for the growth of tumor cells. With the prolonged survival of cancer patients and increased incidence of brain metastases, PTBE occur also gradually increasing. C lear mechanism of PTBE, looking for effective measures to control PTBE, have very important clinical significance.Brain metastases peritumoral edema influencing factors.Objective Clear the relationship between the degree of peritumoral edema of brain met astasis with the clinical pathological characteristics and prognosis.Methods All patients with brain metastases from breast cancer in our unit, who meet the following standards were retrospectively studied.(1) From January 2010 to December 2014, the treated patients with brain metastases from breast cancer;(2) Intracranial metastases 1-3;(3) First found intracranial metastases, radiotherapy and surgery were not performed;(4) Magnetic resonance imaging examination was in our hospital;(5) There were clear pathological findings confirmed as breast cancer;(6) Previous treatment specification,have complete clinical data. Exclusion criteria were as follows:(1) the size of the lesion was less than 3mm;(2)Patients with other malignant tumors;( 3) Associated with cerebral infarction, intracranial hemorrhage and other diseases;(4)The number of intracranial metastases was 4 or more.Make a detailed record of age, sex, tumor stage, histological type, histological grade, lymph node metastasis, disease-free survival, estrogen receptor(ER), progesterone receptor(PR), human epidermal growth factor receptor 2(HER- 2), Ki-67, the time from diagnosed to brain metastases, overall survival, metastatic brain lesion volume when first diagnosed, peritumoral edema volume, the maximum diameter of the lesion, edema index(EI), the distribution in brain lesions and other factors.The edema index represents of peritumoral edema, calculated as EI =(V tumor + V edema) / V tumors. All patients MRI of T1 enhanced image and T2 image were imported into Eclipse treatment planning system(version 7.3 Varian), hierarchical outline lesions and edema region, the system would calculates the volume of the lesions and edema volume of the region.Edema index as dependent variables, age, diameter metastases, the location in the brain metastases, lesions rules or not, the diagnosis to brain metastasis time, ER, PR, Her-2 and other factors were analyzed with rank sum test, SPSS9.2 statistical software was used for analysis. After single factor analysis, multiple regression analysis was performed to analyze the factors related to the edema index. The relationship between survival time after brain metastasis and various other factors was analyzed by Cox regression analysis.Results The study enrolled a total of 62 cases of breast cancer patients with brain metastases 1-3, 66 lesions, age 26-61 years, median age 44 years, median edema index 3.50. Triple-negative breast cancer(TNBC), HR(-) / HER-2(+), HR(+) / HER-2(-), HR(+) / HER-2(+)breast cancer, respectively 18 cases, 16 cases, 15 cases, 13 cases.TNBC and non-TNBC patients mean edema index were 8.11, 4.66 respectively, Mann-Whitney rank sum test p = 0.042, statistically significance.ER(-) and ER(+)patients mean edema index were 7.34, 2.88 respectively, Mann-Whitney test p = 0.046, statistically significance. PR(-) and PR(+) patients mean edema index were were 6.97, 2.84 respectively, row Mann-Whitney test p = 0.040, statistically significant. HER-2(-) and HER-2(+)patients mean edema index were 5.87, 5.46, Mann-Whitney test p=0.639, no statistical significance.Age ≥45 and <45 patients mean edema index were 7.74,3.56, Mann-Whitney mean edema index p = 0.02, row Pearson correlation analysis, the correlation coefficient was 0.346, correlation coefficient row hypothesis test results for p = 0.004.Rule lesions and irregular lesions mean edema index were 4.66 and 8.51, Mann-Whitney test line p = 0.03, statistically significant.Based on the location of brain metastasis, patients was divide d into parietal, frontal and temporal lobe, occipital lobe, cerebellum groups, the mean edema index were 6.78,3.18,8.20,8.30,3.02, row Kruskal-Wallis rank sum test showed p-value 0.441, not statistically significant.Patients 1-3 with brain metastases in this study was found had a median survival time of 28 months, according to the edema index 3, 5, 8, 10, 12, rows survival analysis, found no survival time change due to changes in edema index.Cox proportional hazard regression model was performed to analyze the brain metastases survival time of all the data. It was concluded that the survival time after brain metastases may be related to the 5 factors, such as PR, molecular typing, visceral metastasis, targeted therapy, or local treatment. The single factor analysis showed no statistical significance respectively.Factors such as ER, PR, Her-2, age of onset, severity of lesions, enhancement, diameter of lesion and location of brain metastases were analyzed. Obtain Y = 1.839-4.476(ER) +0.180(patient age)-3.347(rule lesion), where ER positive =1, ER negative = 0, rule lesions = 1, irregular lesions = 0. Suggested that the edema index was related to the ER condition, the age of diagnosis and the rule of the lesion.Conclusion1 Triple negative, hormone receptor-negative, age ≥45 years of age, irregular lesions of breast cancerpatients with brain metastases are possible with serious peritumoral edema;2 Univariate and multivariate analysis showed edema index does not affect the prognosis of patientswith breast cancer brain metastases. However, the present study sample size less than normal, needto be confirmed by further studies.Analysis of curative effect of bevacizumab in the treatment of refractory peritumoraledema.Objective Definite curative effect and adverse reaction of bevacizumab in the treatment of refractory peritumoral edema.Methods Reviewed the patients receiving bevacizumab meet the following criteria.(1) Patients treated in March 2009 to December 2015;(2) PTBE was confirmed by magnetic resonance imaging examination;(3) The effect was not obvious after more than 3 days of mannitol or glucocorticoid treatment;(4) The purpose of bevacizumab treatment was to alleviate PTBE;(5) Previous treatment specification. Follow-up records and clinical data was complete. Exclusion criteria:(1)Lesion size below 3mm;(2) Patients Accompanied by other malignancies;(3) Do not have cerebral infarction, epilepsy, cerebral hemorrhage and other intracranial diseases;(4) Combined with chemotherapy to reduce the peritumoral edema. Recording the patients age, sex, disease, clinical stage, prior treatment, concomitantdiseases, quality of life scores before and after the application of bevacizumab treatment, clinical symptoms and signs, imaging results, side effects. Judge the degree of edema by edema index, EI =(V edema + V tumor) / V tumor, the tumor and edema volume is assumed to be elliptical sphere, according to the spheroid volume formula: V = π / 6 × abc computing volume, a, b, c are the largest perpendicular diameters of three directions.Results Our hospital in March 2009 to December 2015 received bevacizumab treated patients 212 cases in room, 121 patients, 59 patients were reviewed of magnetic in my unit. Outpatient bevacizumab patients 187 cases, 111 patients, using nuclear magnetic resonance reviewed 54 patients; Because patients without reviewed NMR would not be able to measure edema index, so removed the patients did not review the MRI, put outpatient and inpatient with bevacizumab and review NMR patients together, for a total of 54+59=113 patients.59 patients used bevacizumab for pure relieve edema while other patients combined with chemotherapy. In 59 cases, the male and female were 24 and 35, respectively, median age 52(22-74) years, 21 cases, of glioma, 19 cases of lung cancer, 14 cases of breast cancer, cervical cancer, esophageal cancer, colon cancer, maxillary sinus cystadenocarcinoma 1 case respectively.All the patients average 1.71 times, 1 times the median medication, most medicines 4 times, the average dose of 4.68mg/kg, the highest dose of 6.52mg/kg, the lowest dose of 2.80mg/kg. During two administration, the interval was 2 weeks, and the longest interval was 12 weeks.In 59 cases, 50 cases were improved after the treatment, and the effective rate was 84.74%. Brain MRI showed edema was significantly reduced, the average PTBE volume before and after was(125583.43 + 14093.27mm3 Vs71613.42 + 9473.42 mm3, P < 0.01). Average edema index was significantly lower than before(25.66 + 11.54 VS 17.87 + 6.87, P<0.01). In the simple application of bevacizumab without radiation interference of 44 cases of patients, PTBE volume before and after contrast(135810.77 + 16643.51mm3 Vs74432.61 + 10028.59 mm3, P < 0.01), edema index before and after contrast(15.24 + 281 vs 13.05 + 358, P < 0.01).There were 11 cases in 59 patients had high blood pressure.The probability of the occurrence of hypertension was 18.6%, High blood pressure can be reduced to normal levels after oral antihypertensive drugs. No other complications occurred.Conclusion 1 Hormones, mannitol and other conventional therapy of cerebral edema in patients with refractory peritumoral can consider the application of bevacizumab treatment, but need to be wary of bleeding or other serious adverse reactions; 2 Patients treated with bevacizumab for high edema index of curative effect is better than that of low index in patients with edema 3 The current commonly used dose of bevacizumab for the treatment of intracranial refractory edema was 5mg/kg. In this study, there is still a significant effect in some patients with lower doses(2.8mg / Kg) of bevacizumab. That bevacizumab peritumoral edema dosage is worthy of further study. |
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