| Objective: To investigate the efficacy and safety of bevacizumab in combination with whole brain radiotherapy in patients with multiple brain metastases from driver gene expression-negative lung adenocarcinoma.Method: Patients diagnosed with brain metastasis of lung adenocarcinoma with negative driver gene expression from January 2020 to October 2021 were collected and randomly grouped into trial and control groups,with bevacizumab combined with whole brain radiotherapy(WBRT+BV)in the trial group and whole brain radiotherapy(WBRT)alone in the control group.The whole brain radiotherapy plan of the two groups of patients was as follows: the total dose was 30Gy/3Gy/10 f.Patients in the experimental group were treated with bevacizumab at a dose of 5 mg/kg on the first day of radiotherapy,once every 2 weeks,and completed 6 cycles.Baseline assessment was completed by completing cranial enhancement MRI and quality of life evaluation before treatment,quality of life was evaluated using the Activity of DAily Living Scale(ADL).The patients’ quality of life was measured and evaluated at the 1st,2nd and 3rd months after the completion of radiotherapy for measurable lesions and the occurrence of adverse reactions after drug administration.Results: The ADL scores in the WBRT group were 60(55,60)and 80(75,80),the peritumoral edema volume was 45.2(39.1,54.8)cm3 and 24.2(22.2,36.6)cm3,the brain metastasis volume was 17.8(11.9,29.5)cm3 and 10.4(4.6,21.3)cm3,the edema indices of 14.4(8.6,19.5)and 7.1(4.5,8.9)before and after treatment respectively;In the WBRT+BV group,the ADL scores were 60(50,65)and 90(80,95),the peritumoral edema volume was 51.3(44.5,58.2)cm3 reduced to and 8.7(3.7,12.1)cm3,and the brain metastasis volume was 18.8(16.9,26.1)cm3 reduced to and 3.1(2.1,5.8)cm3,The edema index was 16.1(9.6,19.2)and 3.1(1.7,4.5)before and after treatment,respectively;The ADL scores,peritumoral edema,brain metastasis volume,and edema index were statistically significant in both groups(P < 0.05).After the 3rd month of treatment in both groups,the efficacy was evaluated according to them RECIST criteria,in the WBRT group,2(6.7%)patients had Progressive Disease(PD),8(26.7%)patients had Stable Disease(SD),18(60%)patients had Partial Response(PR),and 2(6.7%)patients had Complete Response(CR).In the WBRT+BV group,2(6.7%)in complete response(CR);1(3.6%)patient in PD,8(7.1%)patients in SD,18(71.4%)in PR,and 2(17.9%)in CR.The Disease Control Rate(DCR)of patients in the WBRT group was 93.3%,and the DCR of patients in the WBRT+BV group was 96.7%;the DCR of patients in both groups was not statistically significant(P > 0.05);the Objective Response Rate(ORR)of patients in the WBRT group was 66.7%,and the ORR of patients in the WBRT+BV group was 89.3%,and the ORR of patients in both groups was statistically significant(P < 0.05).The ORR of the WBRT+BV group was 89.3%,and the ORR of the two groups was statistically significant(P < 0.05).Adverse reactions that occurred were: in the WBRT group,10(30.0%)had bone marrow suppression,7(23.3%)had leukopenia,1(3.3%)had anemia,2(6.7%)had thrombocytopenia,4(13.3%)had hypertension,1(3.3%)had nasal bleeding,and 5(16.7%)had constipation;in the WBRT+BV group,13 patients had bone marrow suppression(46.4%),including 8 patients(28.6%)with leukopenia,2 patients(27.1%)with anemia,3 patients(10.7%)with thrombocytopenia,6 patients(21.4%)with hypertension,2 patients(7.1%)with venous thrombosis,3 patients(10.7%)with proteinuria,4 patients(14.3%)with nasal bleeding,4 patients(14.3%)with constipation after treatment,their The incidence of adverse reactions was not statistically significant(P > 0.05).Conclusion: Bevacizumab combined with whole brain radiotherapy can effectively reduce peritumoral edema,inhibit the growth of brain metastases,improve patients’ ADL scores and enhance patients’ quality of life in patients with multiple brain metastases from driver gene expression-negative lung adenocarcinoma;the adverse effects can be tolerated during treatment. |
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