Clinical Study Of Bevacizumab In The Treatment Of Intractable Peritumoral Edema Of Adenocarcinoma Brain Metastases

Objective Brain metastases are often accompanied by severe peritumoral edema.This study intends to explore the difference between bevacizumab and mannitol combined with dexamethasone in the treatment of two treatment methods,so as to provide a better choice for the treatment of intractable peritumoral edema in adenocarcinoma brain metastases.Methods The data of 100 cases of adenocarcinoma brain metastases with intractable peritumoral edema treated at the head gamma knife treatment center of affiliated Hospital of Inner Mongolia Medical University from July 2018 to September 2020were analyzed.The primary lesions of all patients were confirmed as malignant tumors by pathological examination.The head magnetic resonance examination showed that there were measurable metastatic lesions in the brain,obvious edema around the lesions and edema still existed for a long time after treatment.The patients treated with bevacizumab were the treatment group,and the patients treated with mannitol combined with dexamethasone were the control group.Before treatment,the karnofsky functional status score,brain metastases volume,peritumoral edema volume and edema index were recorded.After 1 month,the head enhanced magnetic resonance was re-examined,the edema index,edema volume,tumor volume after treatment were recorded,and the changes of Karnofsky functional status score and the occurrence of drug-related adverse reactions were followed up 1 month and 3 months after treatment.Results After treatment,the symptoms of most patients in the treatment group were improved to varying degrees,and the curative effect lasted longer,the Karnofsky score was higher than before treatment,and there was’t symptom aggravation in the patients;Symptoms of 26 patients(52%)in the control group could be alleviated in a short period of time,but the symptoms of 19 patients(38%)were aggravated,and the symptoms of the remaining patients did not change significantly.After treatment,the Karnofsky score of the two groups were[80.0(60.0,90.0)]vs.[55.0(50.0,60.0)],(P<0.05).The curative effect of peritumoral edema in the treatment group was better.The curative effect was evaluated as edema relief in 40 cases(80%).Although some patients in the control group could improve their condition in a short period of time,the duration was short,The curative effect was evaluated as progress in 43 cases(86%),and no curative effect was evaluated as edema relief.After treatment,the volume of peritumoral edema decreased from[59.1(36.7,121.2)cm~3]to[2.2(0.0,17.6)cm~3],but the volume of peritumoral edema increased from[70.3(37.8,112.9)cm~3]to[83.0(44.8,141.5)cm~3]in the control group.The difference of peritumoral edema between the two groups was statistically significant(P<0.05).Edema index was[10.1(7.6,14.3)]in the control group and[2.0(1.0,3.6)]in the treatment group(P<0.05).And the tumor response of patients treated with bevacizumab also showed better efficacy,the tumor volume of the control group and the treatment group was[7.6(4.4,17.7)cm~3]vs.[2.7(1.1,5.0)cm~3],(P<0.05).In the control group,there were many adverse reactions,including high blood sugar,insomnia and neurological symptoms,thirst with polyuria,digestive tract discomfort and so on,affecting the treatment and needed to deal with adverse reactions.Treatment group patients with good tolerance,only 1 patient due to refractory hypertension,resulting in suspension of treatment.Among the other patients,10 cases of I degree bone marrow suppression,3 cases of epistaxis,4 cases of gingival bleeding,1 case of hematuria,1 case of skin pruritus,no obvious organ hemorrhage and serious adverse reactions of III-IV degree.Conclusions Bevacizumab is effective in the treatment of intractable peritumoral edema of adenocarcinoma brain metastases.It can significantly reduce the volume of peritumoral edema and quickly alleviate the clinical symptoms of patients.The quality of life of patients can be improved significantly.It can be used to replace steroid hormone.The occurrence of adverse reactions can be controlled,the patient is well tolerated,and has good curative effect on solid tumor and cystic tumor.To sum up,bevacizumab is safe and effective in the treatment of intractable peritumoral edema of brain metastases.